Make the World a Better Place

Please choose one or multiple dates that your child will be attending. Each week is limited to 25 registrations, after the 25 has been met there will be a wait list.

I will have paper forms each week for families to sign.

Program is for kids in grade K-5

Any questions, contact Jordan Wygant 304-596-9948 jwygant@gscnc.org

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* 1. Which Day(s) are you signing up for?

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* 2. What is your Child's Name?

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* 3. Child's age and birth date

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* 4. Child's School and Grade as of Fall 2018

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* 5. Child's Address

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* 6. Mother/Guardian

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* 7. Father/Guardian

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* 8. If Divorced or legally separated, please indicate the custodial parent(s)

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* 9. Emergency Contact #1

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* 10. Emergency Contact #2

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