Learner's Club Registration

January Learner's Club will be offered on Mondays & Tuesdays.
This month's topics are:

"Rockets in Space" (Mondays) & "Winter!" (Tuesdays).

Child's Name*

First NameLast Name

Child's Date of Birth*

Parent/Guardian Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email*

Phone Number*

Area CodePhone Number

Allergies, Special Needs, and Additional Details:

Photo/Video: During Learner's Club, photos and/or videos will be taken for use in ministry promotion for HCLC. Names will not be used. If your child cannot be photographed, please send a written request (not on this form) to the Learner's Club teacher. Thank you.

Please type your name in this box for media release.

The price(s) below include a non-refundable 3% convenience fee.

Registration*

MONDAYS - Rockets in Space$90.00

(1/5, 1/12, 1/26)

TUESDAYS - Winter!$120.00

(1/6, 1/13, 1/20, 1/27)

Total $0.00

Credit Card Information