Club 66 2026-2027

Please fill out this form and click submit. If you have questions, please contact Katie Doel: katie.doel@laurelwoodbc.com

Parent Information

Parent Name #1

*

Parent Name #2

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Name of church family attends

*

Child Information

Please enter the information for each child you are enrolling in Club 66.

Name Child #1

*

Grade (Fall '26)

*

Birthdate

*

Medical Concerns (Allergies, ADHD, Anxiety, etc)

T-shirt size

*

Please select all that apply.

Child Small Child Medium Child Large Child XL Adult Small Adult Medium Adult Large

My child's photo may be taken and used for promotional purposes

*

Please select one option.

Yes No

Name Child #2

Grade (Fall '26)

Birthdate

Medical Concerns (Allergies, ADHD, Anxiety, etc)

T-shirt size

Please select all that apply.

Child Small Child Medium Child Large Child XL Adult Small Adult Medium Adult Large

My child's photo may be taken and used for promotional purposes

Please select one option.

Yes Option

Name Child #3

Grade (Fall '26)

Birthdate

Medical Concerns (Allergies, ADHD, Anxiety, etc)

T-shirt size

Please select all that apply.

Child Small Child Medium Child Large Child XL Adult Small Adult Medium Adult Large

My child's photo may be taken and used for promotional purposes

Please select one option.

Yes No

Name Child #4

Grade (Fall '26)

Birthdate

Medical Concerns (Allergies, ADHD, Anxiety, etc)

T-shirt Size

Please select all that apply.

Child Small Child Medium Child Large Child XL Adult Small Adult Medium Adult Large

My child's photo may be taken and used for promotional purposes

Please select one option.

Yes No

Emergency Contact Info

Please list the names of other adults who may pick up your children.

Name #1

Name #2

Name #3

Emergency Contacts (Please list in order of priorty).

Name

*

Relationship to child

*

Phone

*

Name

*

Relationship to child

*

Phone

*

Medical Release

Please complete a medical release form for each of your students in Club 66. Print and bring to the first Club night on September 17th. Click here to download the form: Medical Release

Registration Fee

Registration is $20/child due by Sunday, August 2nd. You can drop a check off at the Connections Desk on Sundays or click here to pay online: Pay Registraion

Description

Please fill out this form and click submit. If you have questions, please contact Katie Doel: katie.doel@laurelwoodbc.com

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