Registration Form

* Indicates required field

Child's Name *

First

Last

Child's Date of Birth *

Child's Address *

Phone Number *

Parent(s) name *

First

Last

Email *

Session *

Morning Session 9:00-11:30 AM Afternoon Session 12:30-3:00 PM

I understand that I must have a current medical statement signed by a physician for my child not later than 30 days after my child's admission. *

Yes No

I understand that my child is not registered for class until I pay my $75.00 registration fee. *

Yes No

How did you hear about us *

Submit

Make checks payable to : Central Christian Church

1504 Villa Rd.

Springfield, OH 45503