Church on the Rock - Creation Lab Registration

First Name (Attending Parent):

Last Name (Attendng Parent):

Email Address:

Phone Number Type:

Home
Work
Cell

Phone Number:

Names of Other Teens or Adults Attending Seminars Only:

Please enter the names of other teens or adults attending on a separate line in this box.

Number of Children Participating:

Names and Ages of Children Attending:

Please enter the name and age of each child attending on a separate line in this box.

Number of Children for Child Care:

Names and Ages of Children for Child Care:

Please enter the name and age of each child in need of child care on a separate line in this box.

Creation Seminars are free for everyone to attend.

Creation Workshops (excluding Lab) are free for everyone to attend.

Creation Lab (9:00am - 11:30am, Saturday 18 Sept 2010 only) cost is $5.00 to defray cost of lab kit.