District Assembly Kids Program Registration
District Assembly 2026
Parent's Name
*
First Name
Last Name
Parent's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Can we text that number?
*
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What church do you attend?
*
Child #1 Name
*
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
Date
What grade?
*
Please Select
0-1 years old
2-3 years old
4-5 years old
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Snacks will be provided are there any allergies we need to be aware of?
*
Child #2 Name
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
What grade?
Please Select
0-1 years old
2-3 years old
4-5 years old
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Snacks will be provided are there any allergies we need to be aware of?
Child #3 Name
First Name
Last Name
Birthday
-
Month
-
Day
Year
Date
What grade?
Please Select
0-1 years old
2-3 years old
4-5 years old
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Snacks will be provided are there any allergies we need to be aware of?
Will your child/children be attending one or two days? (please select all that apply)
*
April 24
April 25
Submit
Should be Empty: