Starts September 11!

Delta club is a mid-week children's ministry program for children in 1st – 6th grade, in memorizing Bible verses, studying Bible lessons, playing games together, learning life skills and doing fun activities together, all while earning special awards. We meet in the church building downstairs in the Social Hall.

$25 suggestion donation
For more information, please contact Kathey Chellsen @ 925-550-9667 or katheychellsen@gmail.com.

Windborn Church
Delta Club Registration

Every Wednesday Evening 6:15 p.m. -- 7:45 p.m.
September 11, 2024 -- May 21, 2025
1st grade -- 6th grade

Child's Information

Child's First Name

Last Name

Birthdate

Grade just started

T-Shirt Size

Child's Address

(Apartment Number)

City

State

Zip/Postal Code

Allergies

Anything else you would like us to know?

Parent's/Guardian's Information

Parents/Guardians's First Name

Last Name

Email

Phone Number

Home Church

Emergency Contact

Emergency Contact First Name

Last Name

Phone Number

Medical Information

Insurance Company

Doctor's First Name

Last Name

Phone Number

Authorization

I hereby authorize adult volunteers of Windborn Church of Rio Vista, CA, as agent(s) for the undersigned, to consent to any medical or surgical care deemed advisable by any accredited physician or surgeon in an approved emergency clinic, facility or hospital.

Yes

I further release from any liability. Windborn Church of Rio Vista, CA, and any of it’s ministries or leaders in the event of an accident during Delta Club and/or en-route, during and/or returning from the above mentioned event. This agreement does not apply to claims for intentional misconduct or gross negligence.

Yes

Do you give permission for images of your child, captured during Delta Club events through video or photo, to be used for the purposes of Windborn Church promotional material and publications?

Yes

No

Signature

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Starts September 11!

Windborn Church
Delta Club Registration

Child's Information

Parent's/Guardian's Information

Emergency Contact

Medical Information

Authorization

Get In Touch/Prayer Request

Contact Info

Starts September 11!

Windborn ChurchDelta Club Registration

Child's Information

Parent's/Guardian's Information

Emergency Contact

Medical Information

Authorization

Get In Touch/Prayer Request

Windborn Church
Delta Club Registration