Parent's Name

Email Address

Street Address

Unit

City

State

Zip Code

Child's Name

Birth Date (mm/dd/yyyy)

Pick the club your child will attend: Pick the club your child will attend: Rainbow's Club (Ages 3 - 4) Dasies' Club (Kindergarten) Prim's Club (1st - 2nd grade) Stars' Club (3rd - 5th grade) Friend's Club (6th - 8th grade) Girls Only Club (9th - 12th grade)

Child's Church? Child's Church? Attends KC Does not attend a church Attends another church

Other church name

Your name

Check all that apply Check all that apply I would like to sign up more than one child. I would like more information about Royal Rangers clubs for boys. I know other girls I would like you to contact about Mpact Girls. I would like to sponsor a new Mpact Girl (tax-deductible donation of $30). I would like to know more about King's Chapel in Lebanon. I would like to donate to Mpact Girls Ministries in Lebanon.