DivorceCare for Kids (DC4K) Sign-up | Eastern Hills Community Church

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Even though we are a community church, we are affiliated with a denomination called the Christian Reformed Church (CRC).

* required
* Registering Parent First Name:
* Registering Parent Last Name:
* Email:
Telephone:
Address:
List your child/childrens name(s) and age(s): :
Are parents separated or divorced?	Separated Divorced
How Long? :
Will the registering parent be attending DivorceCare?	Yes No
Space is limited, so kids whose parent is attending the adult program will get preference over those whose parent does not.
Describe the child's family situation and living arrangement: :
Describe the custody and visitation agreement: :
Does your child have any allergies, especially food allergies? If so, please specify: :
Is there anything else the leaders should know about your child? If so, please specify: :
Who will be picking up the child/children? :
Is there anyone who may NOT pick up the child/children? :
In case of emergency please contact the following person (list name and phone number): :
Consent and Release I understand that DC4K is not a counsesling service or therapy program but a biblically based, Christ-centered program to help children of separation or divorce heal in a group setting. DC4K is designed to bring childrend of divorce into the loving arms of a church family and to feel God surrounding them. By submitting this form, you agree to this statement.
* Security code:

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