DivorceCare For Kids

Please return by January 20, 2011

DC4K will begin at Triangle Presbyterian Church Thursday, January 20th.  The program will run from 5:45-7:45 each Thursday for 13 weeks and will include a simple dinner for parents and kids with a kid friendly menu for $4 per adult and $2 per kid with a $10 family maximum charge. The program will include a variety of simple and non-threatening activities for children to choose among.  The goal is to provide a safe place with activities that are intended to help kids work through their feelings.  There will be consistent staff including trained teachers as well as other loving volunteers.  Activities include a simple craft time, a personal activities book relating to the weekly discussion topic, music, a DVD presentation entitled "Kids Just Like Me" and a weekly Bible story video.  Triangle Presbyterian Church is located on HWY 54 at 5001 Tudor Place approximately 1 mile from Southpoint Mall.

NOTICE: all information entered into this form will be sent in plain text format, via e-mail, to the TPC office. If you are not comfortable with e-mailing this information, then INSTEAD use the PDF registration form. Download it, fill in the information, print it, and turn it in at the TPC office.

* Name: * Age: * Grade:

* Birth Date:
Name: Age: Grade:

Birth Date:
Name: Age: Grade:

Birth Date:
Name: Age: Grade:

Birth Date:
Name: Age: Grade:

Birth Date:
* Address
* City:   * State: * Zip:
Please include at least one phone number.  Home:    Cell: 
Person(s) the child lives with and relationship:
How did you hear about DC4K?

Note * required information to submit online


If you plan on bringing children to our child care (available for children younger than kindergarten age), please list their names and ages below:

Name: Age:
Name: Age:


Registration fee is $10 per child for the 13 week session.  This covers all 13 weeks' activities, materials, and book.  (Meals are extra, payable at mealtime.)  Please bring the registration fee with you to the first session, or you may turn it in before then at the Triangle Presbyterian Church Office.

Registration Fee: $

We do not want finances to keep your child from coming to our DC4K group.  If you need help with the registration fee, all you have to do is check this box and the registration will be paid from our scholarship fund:

Meals are available each week at a cost of $4/adult, $2/child with a family cap of $10. For planning purposes, we would like to get an idea of how many people might be interested. You are not obligated to participate nor prohibited from participating regardless of your answer here. How many adults and children in your family might be interested in meals each week?

Adults:

Children:

* Your Name:  * Your Email:

Notice: When you click the "Submit" button, your information will be sent in plain text format via e-mail to the TPC office.