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We're looking forward to serving You & Your Kids!

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Cell Phone Number

Best way to contact you
Phone Email

# of Children you're signing up
1 child 2 children 3 children 4 children 5 children Help! ;-)

Children (first name only is fine)

Age Group of Your Children (select all that apply)
6 weeks - 5th grade Middle School student(s) High School student(s)

Please indicate allergies your child may have, medications your child currently takes or can NOT take, special dietary needs, and any medical conditions that would prevent him/her in participating in any activities. Write "NONE" if there are none.

Additional Emergency Contact Name (optional)

I understand that my child(ren) will be participating in a number of activities which carry with them a certain degree of risk. I consent for my child(ren) to participate in these activities.
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I authorize my child(ren) or the child(ren) for whom I have legal guardianship to be included in social media posts by CCSM.
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Church address: 3254 Lori Dr, Belmont, CA 94002

Matthew 19:14

CALVARYSANMATEO

3254 Lori Drive, Belmont, CA 94002
650-888-1784