Kids Ministry Registration

Please fill out this form and click submit.

Parent 1

Name

*

Date of Birth (optional)

Mobile

*

Email

*

This address will receive a confirmation email

Gender

*

Please select one option.

Male Female

Headshot

Upload (8MB)

Parent 2

Name

Date of Birth (optional)

Mobile

Email

Gender

Please select one option.

Male Female

Headshot

Upload (8MB)

Household information

Home Phone

Address

Child 1

Name

*

Birthday

*

Phase or Grade (Spring 2024)

*

Please select one option.

Crawler 2 Year Old 3 Year Old (potty trained) 3 Year Old (not potty trained) 4 Year Old 5 Year Old Kindergarden 1st 2nd 3rd 4th 5th

Special Instructions / Allergies

Gender

*

Please select one option.

Male Female

Headshot

Upload (8MB)

Child 2

Name

Birthday

Phase or Grade (Fall of 2022)

Please select one option.

Crawler 2 Year Old 3 Year Old (potty trained) 3 Year Old (not potty trained) 4 Year Old 5 Year Old Kindergarden 1st 2nd 3rd 4th 5th

Special Instructions / Allergies

Gender

Please select one option.

Male Female

Headshot

Upload (8MB)

Child 3

Name

Birthday

Phase or Grade (Fall of 2022)

Please select one option.

Crawler 2 Year Old 3 Year Old (potty trained) 3 Year Old (not potty trained) 4 Year Old 5 Year Old Kindergarden 1st 2nd 3rd 4th 5th

Special Instructions / Allergies

Gender

Please select one option.

Male Female

Headshot

Upload (8MB)

Child 4

Name

Birthday

Phase or Grade (Fall of 2022)

Please select one option.

Crawler 2 Year Old 3 Year Old (potty trained) 3 Year Old (not potty trained) 4 Year Old 5 Year Old Kindergarden 1st 2nd 3rd 4th 5th

Special Instructions / Allergies

Gender

Please select one option.

Male Female

Headshot

Upload (8MB)

If you have teenagers:

Teenager(s) name, grade, email (optional), cell phone (optional):

Other stuff

Please list any adults, not previously listed, that are authorized to pick up your children

Notes:

Description

Please fill out this form and click submit.

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