"Shine" Children's Wednesday
After School Program
Eph. 2:8-10, Phil. 2:14-16a
Wednesdays Afterschool-6pm
CUP Evangelical Presbyterian Church
530 Blackhawk Rd. Chippewa
“A program for the advancement of the arts and the gospel”
For Grades 1st-6th
What it is: This is a free program designed for children grades 1-6. The program provides an extracurricular opportunity focused on further developing your child’s talents in music and drama. In addition to these, the program will also include a time for recreation and sports, snack, and Bible lesson. The Wednesday afterschool program will conclude each week at 6:00pm, where a dinner will be held for all children and their families (don’t worry about cooking). For More information Contact: Nathan Bryant- Children’s and Youth Director 724-843-1594 or 724-683-7154 / Bryantna1@gmail.com
"Shine" Children's Registration Form
Please drop off completed forms at Church - Printable from Online and also available from church
Child’s Name: ______________________________________________
School Attending and Grade: ___________________________________
Home Address: _____________________________________________ __________________________________________________________
Phone #: ___________________________________________________
Any food allergies: ____________________________________________
Any special needs, restrictions, or health concerns: ___________________________________________________________
Parent or Guardians Name: _____________________________________
Address: ____________________________________________________ ___________________________________________________________
Contact Number: ______________________________________________
Work Number: ________________________________________________
Church Affiliation: _____________________________________________
In case parent is unable to be reached:
Emergency Contact: ___________________________________________
Relation to Child: _____________________________________________
Contact Number: ______________________________________________
Transportation from school (Circle)
1) Need a ride (Bus or Van)
2) Parent will bring and drop off
3) other(explain)
Besides those on this sheet, names of those allowed to pick up your child after the program concludes: __________________________________________
__________________________________________________________
