Regeneration Childcare Form - Grace Fellowship Church

Parent Name *

First

Last

Parent Email *

Parent Phone # *

*Cell # preferred

Please list the NAME and AGE of all children needing childcare: *

Do you serve on the re:generation leadership team? *

yes
no

*Members of the leadership team may begin child drop-off at 5:15pm to accommodate the leaders' meeting.

Childcare staff are paid employees, so donations help us to continue to provide childcare. Please provide a donation if you are able to do so. (Suggested donation of $5/child weekly or $25/child monthly).

Total

$ 0.00

Credit Card - Leave blank if not donating

Card Number

Security Code

Name on Card

Expiration/

Re:generation

Register for Re:generation Childcare

2314 South Greenwood Drive, Johnson City, Tennessee 37604