Kids 4 Christ Registration & Permission slip
(An after school program for kindergarten through 6th grade)
Beginning on Wednesday, September 17th, the Kids 4 Christ Program will have its first session. Each Wednesday thereafter it will be held after school (from 3:45 P.M. until 5 P.M.). We will not meet when school is not in session or when the school lets out early.
An escort will be provided for the younger children (also, other children as needed) from the Lyons-Decatur Grade School to the Lyons Memorial United Methodist Church. Younger kids (K thru 3rd grade) and others needing the escort service will meet at the North Door of the Grade School on Lincoln Street (between 3:30 P.M. & 3:40 P.M.). They will be escorted by 2 adults for 3 ½ block to the Memorial United Methodist Church. Any questions, please contact Michelle Roscoe at (402) 687-2576, or her cell number (402) 307-0242.
– – – – – – – – – – – – – – – – – – – – – – – – – – – – Please return as noted below – – – – – – – – – – – – – – – – – – – – – – – – – – –
I give permission for my child(ren) to attend Kids 4 Christ.
Name:__________ Grade:____ Birthday_________ Food Allergies (if any):________________
Name:__________ Grade:____ Birthday_________ Food Allergies (if any):________________
Name:__________ Grade:____ Birthday_________ Food Allergies (if any):________________
Parent or Guardian’s Name (signature): ____________________________________________
Address: _____________________________________________________________________
Home Phone ____________; Work Phone ____________; Cell Phone; ____________________
Emergency Phone Number and Name: ____________________________________________
I request my child(ren) to be escorted {___} from the grade school to the Memorial United Methodist Church.
After the session (5 P.M.), my child(ren) will (usually be picked up) (___), or (will walk home) (___).
If there is a change, please let us know.
You may mail in this permission slip to: Michelle Roscoe, 225 County Rd. St, Lyons, NE 68038; or, your child may bring it to his or her first session.
Any questions, please contact Michelle Roscoe at (402) 687-2576, or her cell # (402) 307-0242.
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