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We only need ONE registration per family. Please put the oldest (nursery-age through 5th grade) Child or Student's name in for the Attendee Information!
Select the number of family members by the appropriate age group that will be attending this event!
*RSVP Count	Qty	Price
# of Adults Attending (18 & older)		$0.00
# of Children Attending (Kdg-5th Grade)		$0.00
# of Younger Children Attending (Pre-K & under)		$0.00

*Please list the first and last name of adults that will be in attendance at this event.

*Please list first and last name of children that will be in attendance

*Our family has gluten sensitivities and needs to have a gluten-free alternative, if applicable.

YesNo

*Your Church Home

CCCOtherNone

I understand that there are inherent risks involved in any ministry activity, and I hereby release 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 Central Christian 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 or your family prefer to not be included for any reason, please communicate this to the ministry leader or our Communications Director, Craig Sephton.

List the first & last name(s) of the individual(s) attending that the Media Release is being declined.

*Parent or Guardian's Signature

Other?

*Are you interested in joining Gospel Adventure Club (GAC) on Wednesday nights?

Not InterestedSlightly InterestedVery InterestedAlready part of GAC

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Faith & Family Outreach | Jesus' Birthday on Wednesday, December 17, 2025 @ 6:30 PM