* Select your club location:
Location:
Room:
Time:
Sponsoring Church:
Club Captain:
Email:
Address
*Parent/Guardian information
*Student Information
Health and Wellbeing
Please select any concerns we should be aware of:
After Club
By checking the box below and submitting this form I am registering my child for the Crossroads Club program. I understand that this is a faith-based program, that it is my discretion to enroll my child in this program, and I have read and agree to the terms and conditions above regarding my child’s participation in the program. I also understand that my child will be expected to conform to the Crossroads code of conduct and if s/he does not, I will be notified and they may be removed from the CKC program.