Registration for DC4K

Registration Fee $20.00 (Covers all 13 weeks) *
Will you be attending the adult DivorceCare program? *
Child's Information
Child's Name *
Child's Name
Date of Birth *
Date of Birth
Phone *
Phone
Who has Custody? *
Has your child attended DC4K before? *
Family Information
Mother's Name *
Mother's Name
Phone *
Phone
Father's Name *
Father's Name
Phone *
Phone
Emergency Contact Information (Other Than Parent)
Name *
Name
Phone
Phone
Pick Up Authorization
The following people are authorized to pick up your child. Photo identification may be required.
Name *
Name
Phone *
Phone
Name
Name
Phone
Phone
Consent and Release
DC4K is not a counselling service or therapy program, but a biblically based, Christ-centred program to help children of divorce heal in a group setting. DC4K is designed to bring children of divorce into the loving arms of a church family and to feel God's love surrounding them. *