Event Registration Back to Event Detail 5th Grade C3 Youth Night on Wednesday, April 23, 2025 @ 6:00 PM Login Price: $0.00 *Attendee's First Name: *Attendee's Last Name: *Attendee's Email Address: *Attendee's Phone Number: Country: Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China China, Hong Kong Special Administrative Region China, Macao Special Administrative Region Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Cote d'Ivoire Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French Part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka State of Palestine Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Thailand The former Yugoslav Republic of Macedonia Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom of Great Britain and Northern Ireland United Republic of Tanzania United States Minor Outlying Islands United States Virgin Islands United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe Address Line 1: Address Line 2: City, State Zip: AA AE AL AK AP AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VA VI WA WV WI WY Put the Student's name in for the "Attendee Information." If you login, you may be able to choose your student from the drop-down and your information will auto-populate for the Parent/Guardian Information. Please register each child separately.Tell us how many to expect. We do ask that it be only graduating 5th grade students and their parents.*RSVP CountQtyPriceHow many will be in attendance?123$0.00 List the first and last name(s) of the parent(s) or guardian(s) that will be attending with the student.*Student's Birthday:*Student's GenderFemaleMale*Parent or Guardian (First & Last Name):*Parent or Guardian Phone # (555-555-1234):*How many will be in attendance?:I understand that there are inherent risks involved in any ministry activity, and I hereby release the Central Christian Church and its ministries, hereafter known as the Church; its employees, agents, and volunteers from any and all liability for any injury, loss, or damage to person or property that may occur during the course of the participant’s involvement. I give the employees and/or representatives of the Church permission to authorize emergency medical and dental treatment. In the event that the named participant is injured and requires the attention of a doctor, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is required from a physician and/or hospital personnel designated by the Church, I agree to hold such person free and harmless of any claims, demands, or suits for damages arising from the giving of such consent. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the cost of that medical care not be reimbursed by the health insurance provider. This consent form gives permission to seek whatever medical attention is deemed necessary, and releases the Church, its employees, agents, and volunteers of any liability against personal losses to the participant.*I have read, understood, and accepted the terms of this consent/liability/medical release form. This attendee has my permission to attend this event or activity sponsored by Central Christian Church and its ministries.Central Christian Church and its ministries may use photos, videos, or statements from this event in church-created publications, media releases, information displays, websites, social media, and/or other electronic media. No personal address, phone number, or email address will be included. If you prefer to not be included for any reason, please communicate this to the ministry leader or our Communications Director, Craig Sephton.*Typing your name below provides documentation of agreement with the above statements and will be considered your official signature.Please let us know how you learned about this event! AnnouncementBulletinCCC AppCCC WebsiteDigital SignageFacebookInstagramPostcard or FlyerText or EmailWord of MouthOtherOther? Registration Total: Next C3 Online Login Not Logged In Show Summary (0) Public Links Event Calendar Online Giving Mission Trip Registration Secure Links My User Account My Giving My Purchase History My Contribution Statement My Groups My Events My Subscriptions My Mission Trips