REGISTRANT INFORMATION:
Name
Address
City, State, Zip
Home Phone
Cell Phone
Email
For placement assistance:
I am married single
Age: 20-29 30-39 40-49 50-59 60+ If you have children, please indicate how many and the age group: How many children? Check all that apply: Infant/Toddler Preschool Elementary School Middle School High School College Grown
Do you have a church home? Yes No What church are you attending? How did you hear about the ANCHOR?
Is this your first year in the ANCHOR, or are you returning? First time Returning
Childcare and a Homeschool Class is available for Tuesday & Wednesday morning studies. Please list each child needing childcare:
Name Date of Birth
I am interested in the following ANCHOR Bible Study for Fall 2010: **Please note: Current class members will have priority for limited space available on Tuesday mornings. New registrations will be placed on a first come, first served basis for that session.
Tuesday morning (10:00 a.m. - 12 noon) Tuesday evening (7:00 p.m., off campus) Wednesday morning (10:00 a.m. - 12 noon) CCC staff women (Thursdays at noon) Satellite group >> If interested in a satellite group, please specify day & time :
Please check if applicable: I would prefer Tuesday morning, but I am available for Wednesday if Tuesday is full.
Is there anything else you would like us to consider as we prayerfully connect you to a small group? Please let us know in the box below.
Registration fee: $60 one-time fee $30 one-time fee for CCC staff **If you need financial assistance, please see options below. Childcare fees (these one-time fees cover the whole year): $10 for 1st child $5 each for 2nd/3rd child 4th child is free
Payment Options: I'd like to request a scholarship. I'd like to pay for another woman to be able to attend the ANCHOR. (Option to donate towards scholarships will be available on the next page, after you submit this form.)
