Kingdom Kidz 2023/2024
Please fill in the form below.
Name of Child
First Name
Last Name
Current Grade
none, pre, k, 1-6
Age
Birthdate
use numbers - no dashes 01012021
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
Mark if you DO NOT want your child's photo to be used on social media such as our Facebook page or website.
I do not want my child's photo used.
Submit
Should be Empty: