Captain’s Club

For 3rd thru 5th Grade, 3 until 6 pm
Wednesdays starting September 21, 2011 and running through June 2012. Enrollment is open all year.

It’s a perfect blend of fun and function. Supervised homework time from 3 to 4:30 is followed by games, art, Bible lessons, dinner and a short worship time. Captian’s Club is led by Pastor Chris and Joey Hargrove.
Palisades Elementary 3-5 graders can be picked up in front of the school.

The suggested donation per school year is $60. Please drop off your donations to the Church Office at 801 Via de la Paz, across from Palisades Elementary Charter School.

Captain's Club 2011-2012 | Registration Form

We are excited to have your 3rd to 5th grade child(ren) join us for Captain's Club this year! Please complete one form per child.

Child's Name*
Child's Birthdate*
Child's Grade*
Parent/Guardian Information
Your (Parent/Guardian) Name*
FirstLast
Email*
Phone*
(###)###-#### - Please follow this format
Address
Street AddressCityStateZip Code
Emergency Contact Information
Emergency Contact*
FirstLast
Phone*
(###)###-#### - Please follow this format
Medical Information
Doctor's Name*
FirstLast
Phone*
(###)###-#### - Please follow this format
Allergies/Medical Conditions we should be aware of:
Note: We will need a parent's signature on the doctor's release form.
I need my child picked up from Palisades Elementary and escorted with the group to Captain's Club at the Palisades Methodist Church.
- Yes. I authorize this.
- No. I will drop him/her off myself.
Please list the names of anyone authorized to pick up your child:
Photography Authorization
We occasionally photograph activities. Is it okay to use photos of your child in print material?
- Yes
- No
On our website?
- Yes
- No
In the Palisadian-Post?
- Yes
- No
Please let us know if you have any additional comments or information for us:
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Community United Methodist Church of Pacific Palisades, California

Captain’s Club

Captain’s Club

Captain's Club 2011-2012 | Registration Form

Parent/Guardian Information

Emergency Contact Information

Medical Information

Photography Authorization