Kingdom Kidz Registration 2020

Kingdom Kidz Registration 2020

Please fill in the form below.
Name of Child *

First Name Last Name
Grade of Child *
K-1, 2-3, 4-5
Age
Birthdate
Child's Gender

Male Female
Name of Parent/Guardian *

First Name Last Name
Address
Email Address
Parent/Guardian Phone Numbers *

Home Cell
Name of Additional Emergency Contact *

First Name Last Name Relation to Child
Phone Number of Additional Emergency Contact *

Home Cell
Allergies, Medications, Other Medical Alerts or Concerns *
Should be Empty: