Children's Registration

Children's Registration 2019-2020

(Please fill out one per child)

* Indicates required field

Name *

First

Last

Birthdate *

Grade in school (or indicate if in daycare/preschool) *

Parents' Names *

Parent email: *

Person who brings them to church (if not parents) *

Email of person who brings them to church: email contact (with name) *

Parent Cell Number 1 *

Cell Number 2 *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Allergies, special needs or other notes for caregivers: *

Submit