Kingdom Kidz
2025/2026
Child's Name
First Name
Last Name
Child's Grade
Pre K
Kindergarten
1st
2nd
3rd
4th
5th
6th
Child's Gender
Male
Female
Birth Date
-
Month
-
Day
Year
Date
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
Name
Phone Number
Emergency Contact Relationship to Child
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: