Prom – The Church of Living Water

Proceeds benefit CLW Student Ministries, Roll On Ministry, Crossroads, and Friends of the Sheriff and our local school districts!

Fill out the form below to register! First 60 people registered will be entered for giveaways!

Spots are Limited so register today!

Registration is locked in when payment is secured.

Once your registration is submitted, you will be directed for payment, you may also pay at the Gathering Well kiosk at The Church of Living Water or by check (make check payable to The Church of Living Water with Adult Prom in memo line) Include $75 per person and if choosing childcare – $5 per child.

A special invitation for school district employees! For every registration a percentage will be given back to your school district!

ADULT PROM REGISTRATION

Name

Name (Include Prom date if registering couple)

Address

Email

Phone Number

Do you need Childcare? If yes, please list names, ages and any allergies.

School District Employee?

Warsaw School District

Lincoln School District

Photo Release: I authorize The Church of Living Water the right to take, edit, and make use of any and all pictures or video taken of me during this event.(required)

Yes

Does The Church of Living Water have your permission to send you a follow-up email after the event?(required)

Yes