Kenilworth Union Church Children and Family Ministry Visitor Form
Thank you for visiting!
Today's Date
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Month
-
Day
Year
Date
Parent #1 Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent #1 Mobile Number
*
-
Area Code
Phone Number
Parent #1 E-mail
*
email
Parent #2 Name
*
First Name
Last Name
Tell us more about your visit:
We came for a special event.
We are looking for a church home.
We would like a follow up email with more information about Kenilworth Union Church.
Other
1. ) Child's Name
*
First Name
Last Name
Child #1 Age/ Grade Level as of 9/1/22
Toddler I (0-24mos)
Toddler II (24-36mos)
3yrs by 9/1
4yrs by 9/1
Kindergarten by 9/1
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Child's #1 Birth Date
*
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December
Month
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31
Day
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
2.) Child's Name
First Name
Last Name
Child #2 Age/ Grade Level as of 9/1/22
Toddler I (0-24mos)
Toddler II (24-36mos)
3yrs by 9/1
4yrs by 9/1
Kindergarten by 9/1
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Child's #2 Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Use this space to share allergy, medical or other important information about your child(ren):
Parental Release Forms
Photo and Video Parental Release
*
I DO consent to the use of photographs/videos and the use of my child(ren)'s name(s) by Kenilworth Union Church on its website, annual report and/or other church-related purposes.
I DO NOT consent to the use of photographs/videos and the use of my child(ren)'s name(s) by Kenilworth Union Church on its website, annual report and /or other church-related purposes.
Parent Signature
*
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