Christmas Candlelight Service Childcare Registration
Campus
*
Lancaster Campus
Myerstown Campus
What service will you be attending?
Sunday, December 22 • 7:00 PM
What service will you be attending?
*
Monday, December 23 • 7:00 PM
Tuesday, December 24 • 4:30 PM
Tuesday, December 24 • 7:00 PM
Parent / Guardian's Name
*
First Name
Last Name
Parent / Guardian's Phone Number
*
-
Area Code
Phone Number
Parent / Guardian's E-mail
*
example@example.com
Spouse's Name
First Name
Last Name
Spouse's Phone Number
-
Area Code
Phone Number
Spouse's E-mail
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many kids are you pre-registering?
*
1
2
3
4
5
Child's Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
Date
Gender
*
Boy
Girl
Current Grade
*
Infant
Toddler
Preschool
Pre-K
Allergies?
*
Yes
No
Please specify:
*
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Gender
Boy
Girl
Current Grade
Infant
Toddler
Preschool
Pre-K
Allergies?
Yes
No
Please specify:
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Gender
Boy
Girl
Current Grade
Infant
Toddler
Preschool
Pre-K
Allergies?
Yes
No
Please specify:
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Gender
Boy
Girl
Current Grade
Infant
Toddler
Preschool
Pre-K
Allergies?
Yes
No
Please specify:
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Gender
Boy
Girl
Current Grade
Infant
Toddler
Preschool
Pre-K
Allergies?
Yes
No
Please specify:
Submit
Should be Empty: