$35.00 per student. Scholarships are available.

REGISTRATION CLOSES ON FEBRUARY 4TH.

Teen/Student Information

Name

First Name

Last Name

Gender

Female

Male

Year/Grade

School

Birth Date

MM

DD

YYYY

Phone Number of Youth

(###)

###

####

Home Address

Please share any medical information, allergies, special needs, developmental delays, or other important info we should know so we can provide a safe and successful time for your child.

Parent/Guardian Information

Email

Phone Number of Parent/Guardian

(###)

###

####

Home Address

P.O. Box and Post Code

D-Now Information

T-Shirt Size (Adult Sizes)

Persons allowed to pick up my teen from Disciple Now.

Payment

The cost for D-NOW goes towards food and a t-shirt but scholarships are available for those who truly need help and want to attend.

By allowing my child to attend programmes at and with Cayman Islands Baptist Church, I acknowledge that the church may capture photo/video images of my child and could feature/include my child in broadcast and print media, on the church web site, and in publications and programs.

Submitted by Parent/Guardian (type name in lieu of signature).

First Name

Last Name

Date

MM

DD

YYYY

For any further questions, contact Pastor Dalmond at pastordalmond@cibaptist.ky or 917-3495.

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