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Fill out this form and we will let you know when the next bible study will happen!
Name
Email Address
Phone
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Wednesday After Early Dismissal 1:45-3:45pm
Childs Name
Parent/Guardian Name
Address
Emergency Contact Information
Phone
Email
Age of Child
Child's Date of Birth
Current Grade in School
Medial Information (please list any food allergies or other allergies)
Pick Up Information (Who will be picking your child up from Kids Club?)
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Location:
1326 Wisconsin St. LeClaire, IA 52753
Phone:
(563) 289-4191
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