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Kingdom Kids Registration Form
These forms are required for your children to attend Kingdom Kids at Souderton Brethren in Christ.
Student's Information
Student Name
*
Gender
*
Male
Female
Age
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Phone
Format: (000) 000-0000.
Please provide information about any allergies and/or special needs (if any).
*
Please call us (215-723-7452) to discuss any special needs to see if we have the ability to best care for your child.
Add another child?
*
Yes
No
If "no" please hit next below.
Student 2 Name
*
Gender
*
Male
Female
Age
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Please provide information about any allergies and/or special needs (if any).
*
Please call us (215-723-7452) to discuss any special needs to see if we have the ability to best care for your child.
Add another child?
*
Yes
No
If "no" please hit next below.
Student 3 Name
*
Gender
*
Male
Female
Age
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Please provide information about any allergies and/or special needs (if any).
*
Please call us (215-723-7452) to discuss any special needs to see if we have the ability to best care for your child.
Add another child?
*
Yes
No
If "no" please hit next below.
Student 4 Name
*
Gender
*
Male
Female
Age
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Please provide information about any allergies and/or special needs (if any).
*
Please call us (215-723-7452) to discuss any special needs to see if we have the ability to best care for your child.
Add another child?
*
Yes
No
If "no" please hit next below.
Student 5 Name
*
Gender
*
Male
Female
Age
Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Please provide information about any allergies and/or special needs (if any).
*
Please call us (215-723-7452) to discuss any special needs to see if we have the ability to best care for your child.
Please hit next below.
If you need to add more than 5 children please complete this form and then fill out another.
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Parent/Guardian Information
Parent/Guardian Name
*
Type first and last name above.
Relationship to Child
*
Parent/Guardian 1 Cell Phone
*
Format: (000) 000-0000.
E-mail
*
example@example.com
School Affiliation
Church Affiliation (if any)
I give permission for a photo, video, or quote of my child to be used to promote Kingdom Kids and Child Evangelism Fellowship.
*
Yes
No
Parent/Guardian Signature
*
I give permission for my child(ren) to attend Kingdom Kids at Souderton Brethren in Christ Church.
Date Signed
*
-
Month
-
Day
Year
Date Picker Icon
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Emergency Contacts/Authorized Pickup
Emergency Contact #1
Please use a different contact other than who is listed as parent/guardian above.
Full Name
*
First Name
Last Name
Relationship to Child
*
Cell Phone
*
Format: (000) 000-0000.
Emergency Contact #2
Full Name
*
First Name
Last Name
Relationship to Child
*
Cell Phone
*
Format: (000) 000-0000.
I give permission for both of the persons listed above to be contacted and to pick up my child in the event that I am unavailable.
*
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Pre-Program Meals
A meal will be provided starting at 6:00pm each Monday evening before the program.
Will you be attending?
Yes
No
If so, how many can we expect?
Parent Coffee Conversation
Don't want to drive all the way home while your child(ren) are at Kingdom Kids? Join us and other parents for coffee conversations! Get to know other parents who are in the same stage of life over a good cup o' joe. Interested? Fill out the form below!
Would you be interested in joining us for parent coffee conversations?
*
Yes
No
Maybe
If so, are there any topics you would be interested in discussing?
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