Please complete the form below (One FORM per CHILD)

2025-26 UpStreet Registration Form

Child's Information

First Name

Last Name

Shirt Size

Shirts are $10 per shirt. Paid at check-in (cash/check) or scan the QR code at the table.

Shirt Option

To help cover costs, we’re asking a $10 donation per shirt.

I'll pay $10 at registration

I'll pay on tithe.ly

I don't want a shirt

Grade

Date Of Birth

YYYY

Child's Age

Child’s Gender:

Male

Female

Name of Parent(s)

First Name

Last Name

Cell Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Church

Are parent(s) helping with UpStreet?

Yes

If yes, where are they helping?

UpStreet Waiver: I, the under signed parent/guardian of the above named child do hereby consent to his/her participation in UpStreet at Cornerstone Community Church (C3). I agree to waive and release (C3) and its volunteers from all claims for damages that may arise, as a result of my child’s participation in UpStreet. I am aware that the above named child may appear in a photographs, or videos, taken by UpStreet staff, and that photographs or videos may be used. I acknowledge and confirm that I have read this entire document before typing my name below.

Please type your name as your signature.

Type Today's Date

YYYY

In Case of Emergency, Please Contact

First Name

Last Name

Phone

(###)

###

####

Relationship to Child

Allergies or Other Medical Conditions

(Please be Specific)

Would you like to Volunteer or have any questions?

Looking forward to a great UpStreet this year!!

This will be forwarded to our UpStreet Director Julie.

Name

First Name

Last Name

Phone Number

(###)

###

####

Message

Please complete the form below (One FORM per CHILD)

2025-26 UpStreet Registration Form

Would you like to Volunteer or have any questions?

(760) 356-1061 • CONTACT@C3HOLTVILLE.ORGP.O. BOX 58 Holtville, CA 92250

(760) 356-1061 • CONTACT@C3HOLTVILLE.ORG
P.O. BOX 58 Holtville, CA 92250