Registration
2022/ 2023 Year
Parent/Guardian Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
My child's photo may NOT be used for promotions and slide shows
My child's photo may be used for promotions and slide shows
My child's photo may be used for internal slideshows only
Are you serving in the NextGen or Youth ministries?
*
Yes
No
Number of children registering
Registration Fee
*
prev
next
( X )
NextGen Kids Registration (per child)
$
5.00
Quantity
1
2
3
4
5
6
7
8
9
10
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Child 1
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2–3 year olds
4–6 year olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 2
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2 – 3 years Old
4 – 6 Year Olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 3
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2 and 3 years Old
4 - 6 Year Olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 4
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2 and 3 years Old
4 - 6 Year Olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 5
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2 and 3 years Old
4 - 6 Year Olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 6
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2 and 3 years Old
4 - 6 Year Olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 7
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Grade
1
2
3
4
5
6
Kindergarten and under registrants
2 and 3 years Old
4 - 6 Year Olds
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 8
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2 and 3 years Old
4 - 6 Year Olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Child 9
Child's Name
First Name
Last Name
Birthdate
-
Month
-
Day
Year
Date
Kindergarten and under registrants
2 and 3 years Old
4 - 6 Year Olds
Grade
1
2
3
4
5
6
If your child needs a new shirt this year, please indicate your child's shirt size below.
T-Shirt size
Youth S
Youth M
Youth L
Adult S
Adult M
Any Allergies or other health needs?
Yes
No
Describe allergen(s) or health needs and actions staff need to follow
Section Submit
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