2019 Adult Ministry Leadership Dinner

Date: Sunday Dec. 8
Time: 5-7pm
Location: CBC Central
*Spouses are welcome
*Childcare available. Please register by Wednesday, December 4th

Name*

First Name

Last Name

Email*

Phone*

Will your spouse be attending?*

Yes No

Which Ministry are you leading a group for?*

If other:*

How long have you been leading your group?*

Where does your group meet?*

Where off campus?*

How frequently do you meet?*

If other:*

Will you need Kids Club?*

If yes, then after submitting this form you will be receive a Kids Club form to complete.

How many children?

Child 1

Name of First Child*

First Name

Last Name

Child's Date of Birth*

Your children will be cared for in a room with the same aged children.

Please list any allergies for your child*

Child 2

Name of Second Child*

First Name

Last Name

Child's Date of Birth*

Please list any allergies for your child*

Child 3

Name of Third Child*

First Name

Last Name

Child's Date of Birth*

Your children will be cared for in a room with the same aged children.

Please list any allergies for your child*

Child 4

Name of Fourth Child*

First Name

Last Name

Child's Date of Birth*

Your children will be cared for in a room with the same aged children.

Please list any allergies for your child*

Child 5

Name of Fifth Child*

First Name

Last Name

Child's Date of Birth*

Your children will be cared for in a room with the same aged children.

Please list any allergies for your child*