A new school year of Delta Club starts September 10!

Delta club is a weekly club program for boys and girls in 1st through 6th grades that points them to Jesus in every aspect of life.
We meet in the church building downstairs in the Social Hall., every Wednesday 6:15 p.m. -- 7:45 p.m.!

Windborn Church
Delta Club Registration

Child's Information

Child's First Name

Last Name

Birthdate

Grade just started

T-Shirt Size

Child's Address

(Apartment Number)

City

State

Zip/Postal Code

Allergies

Anything else you would like us to know?

Parent's/Guardian's Information

Parents/Guardians's First Name

Last Name

Email

Phone Number

Home Church

Emergency Contact

Emergency Contact First Name

Last Name

Phone Number

Medical Information

Insurance Company

Doctor's First Name

Last Name

Phone Number

Authorization

I hereby authorize adult volunteers of Windborn Church of Rio Vista, CA, as agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic, facility or hospital.

Yes

I further release from any liability. Windborn Church of Rio Vista, CA, and any of it’s ministries or leaders in the event of an accident during Delta Club and/or en-route, during and/or returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.

Yes

Do you give permission for images of your child, captured during Delta Club events through video or photo, to be used for the purposes of Windborn Church promotional material and publications?

Yes

No

Signature

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A new school year of Delta Club starts September 10!

Windborn Church
Delta Club Registration

Child's Information

Parent's/Guardian's Information

Emergency Contact

Medical Information

Authorization

Get In Touch/Prayer Request

Contact Info

A new school year of Delta Club starts September 10!

Windborn ChurchDelta Club Registration

Child's Information

Parent's/Guardian's Information

Emergency Contact

Medical Information

Authorization

Get In Touch/Prayer Request

Windborn Church
Delta Club Registration