Children's Church Registration

What's New Kids Registration

Classes are available for children ages nursery to just completed 5th grade.
How many children are you registering?*
Child Information
First Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).*
Second Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).*
Third Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).*
Fourth Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Last Grade Completed*
Medical or other information we may need to know about the child (including food allergies).*
Child Release Information
Parent/Legal Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Names of Persons to which the child (children) may be released to after church (Please provide at least two)*

First NameLast Name
Full Name*

First NameLast Name
Full Name

First NameLast Name
Full Name

First NameLast Name
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 2 Phone Number*

Area CodePhone Number
Media Release
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.

I Agree
Should be Empty:

What's New Kids Registration

Child Information

First Child

Second Child

Third Child

Fourth Child

Child Release Information

Media Release