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Class Registration
A course in mind? Select it here with our template! Form used to signup for class registrations of various educational programs.
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1
Student Name
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First Name
Last Name
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2
Child's Grade (Entering next school year)
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Kindergarten
1st
2nd
3rd
4th
5th
6th
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Kindergarten
1st
2nd
3rd
4th
5th
6th
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3
Child's Birth Date
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-
Month
Day
Year
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4
Guardian #1 Information
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First & Last Name
Phone Number
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5
Guardian #2 Information
First & Last Name
Phone Number
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6
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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7
Elective Choice #1
*
This field is required.
Discover It! (MUST BE ENTERING 3RD GRADE OR OLDER TO PARTICIPATE - Group is capped at 10 kids) Get ready to explore and experiment in this exciting elective option! Be ready to try new things and explore the wonders of Gods creation! All experiments will be completed under adult supervision. Game On! Time to get your GAME ON! Plan to sweat and have fun! We will be playing multiple outdoor games and sports. Tie up those shoe laces and get ready to leave it all on the field, let's go! Get Creative! If you love arts and crafts and being creative, then this elective is for you! We will be using your gifts of creating to make multiple different projects throughout the week!
Please Select
Discover It!
Game On!
Get Creative!
Please Select
Please Select
Discover It!
Game On!
Get Creative!
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8
Elective Choice #2 (choose a different option than previously)
*
This field is required.
Discover It! (MUST BE ENTERING 3RD GRADE OR OLDER TO PARTICIPATE - Group is capped at 10 kids) Get ready to explore and experiment in this exciting elective option! Be ready to try new things and explore the wonders of Gods creation! All experiments will be completed under adult supervision. Game On! Time to get your GAME ON! Plan to sweat and have fun! We will be playing multiple outdoor games and sports. Tie up those shoe laces and get ready to leave it all on the field, let's go! Get Creative! If you love arts and crafts and being creative, then this elective is for you! We will be using your gifts of creating to make multiple different projects throughout the week!
Please Select
Discover It!
Game On!
Get Creative!
Please Select
Please Select
Discover It!
Game On!
Get Creative!
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9
Elective Choice #3 (choose a different option than previously)
*
This field is required.
Discover It! (MUST BE ENTERING 3RD GRADE OR OLDER TO PARTICIPATE - Group is capped at 10 kids) Get ready to explore and experiment in this exciting elective option! Be ready to try new things and explore the wonders of Gods creation! All experiments will be completed under adult supervision. Game On! Time to get your GAME ON! Plan to sweat and have fun! We will be playing multiple outdoor games and sports. Tie up those shoe laces and get ready to leave it all on the field, let's go! Get Creative! If you love arts and crafts and being creative, then this elective is for you! We will be using your gifts of creating to make multiple different projects throughout the week!
Please Select
Discover It!
Game On!
Get Creative!
Please Select
Please Select
Discover It!
Game On!
Get Creative!
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10
Allergies
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11
In emergencies requiring immediate medical attention, your child will be taken to the nearest hospital emergency room. Your signature below authorizes the responsible person from Harvest E-Free Church in Story City, Iowa to have your child transported to the hospital to receive treatment.
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12
Photos are sometimes taken at activities for publicity and promotional purposes, which include, but are not limited to, in-house promotional presentations, church website, and church newsletters. Children's names or other personal information are never used without specific permission. By signing this area, you are releasing Harvest E-Free Church to use photos and/or videos of your child as stated above.
Signing this statement is optional.
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13
Pick Up Authorization
Please list any other people, other than guardians previously listed, who are authorized to pick your child up from High Five.
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14
Suggested Payment
High Five is free will donation this year to help with the cost of materials with a recommended amount of $5 per child. Checks can be made out to Harvest E-Free Church. Please write "High Five" in the memo line. Online Payment: Scan the QR code below or use the follow link: https://www.zeffy.com/en-US/donation-form/47882a9f-4fd8-435a-ae5d-f55a0035f5a0 (please write "High Five" in the additional info. space)
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15
Additional Comments
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