CHILDREN'S MINISTRY REGISTRATION
Please fill out this form and click submit.
Please complete this form (one for each child) to register your child for Children’s Ministry programs.
Child's Name
*
Age
*
Date of Birth
*
Grade
*
School (optional)
Allergies
Special needs for your child
Photo Release
*
Please select one option.
Yes
No
Select Option
Yes
No
PARENT 1 NAME
Name
*
Parent 1 Cell Phone
*
Home Phone (optional)
*
Family Email
PARENT 2 NAME (optional)
Name
*
Parent 2 Cell Phone (optional)
*
Home Phone (optional)
*
ADDRESS
Address 1
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Members(s) of Relevant Church?
*
Please select one option.
Yes
No
Important: What is the best way to reach you in case of emergency?
*
IMPORTANT: What is the best way to contact you in case of emergency?
*
Submit
Description
Please fill out this form and click submit.
×
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