Register
for a Club



Club

* Select your club location:


Location:
Room:
Time:

Sponsoring Church:
Club Captain:
Email:


Household

Address

*

*



*

*

*

Parent/Guardian information

*

*

*

*


Student

Student Information












Health and Wellbeing

Please select any concerns we should be aware of:








After Club




Add another student from the same household




Waiver of All Claims and Assumption of Risk

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.