Palmetto Kids Family Registration
Primary Parent/Guardian
If we need to contact a parent for any reason, this is who we will contact first.
Name
*
First Name
Last Name
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Membership Status
*
First Time Guest
Returning Guest, but never registered
Attend Occasionally
Regular Attender
Associate Member (Snowbird)
Member
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Next Parent/Guardian
If we cannot reach the primary point of contact, this is who we'll try to contact next.
Name
First Name
Last Name
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Membership Status
*
First Time Guest
Returning Guest, but never registered
Attend Occasionally
Regular Attender
Associate Member (Snowbird)
Member
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Children
Any children under 18 in your household
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Boy
Girl
Child's Current Grade
*
Child's Current School
Please share any allergies or special needs for this child.
*
Do you have another child to add?
*
Yes
No
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Boy
Girl
Child's Current Grade
*
Child's Current School
Please share any allergies or special needs for this child.
*
Do you have another child to add?
*
Yes
No
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Boy
Girl
Child's Current Grade
*
Child's Current School
Please share any allergies or special needs for this child.
*
Do you have another child to add?
*
Yes
No
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Boy
Girl
Child's Current Grade
*
Child's Current School
Please share any allergies or special needs for this child.
*
Do you have another child to add?
*
Yes
No
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Boy
Girl
Child's Current Grade
*
Child's Current School
Please share any allergies or special needs for this child.
*
If you have more than 5 children, please list the additional children below with names, ages and grade.
Please tell us anything else we should know about your family.
This might include foster/adoption stories, custody issues, trauma, unique family situation, Pastor's Kid, etc.
Release
Please read the below release and respond accordingly.
I agree that as a participant, my child may be photographed or videotaped during normal activities and these images may be used in church related promotions. I also understand that my child's allergies will be made available to his/her teacher(s) and will be listed on his/her nametag.
I agree.
I disagree.
You selected "I disagree." for the release. Please share with us which part of the release you are declining and why so we can ensure we can follow your wishes.
Submit
Should be Empty: