kidz current registration

Wednesday Night KIDZ Current Registration
pre-school thru 5th grade

* Indicates required field

Child's Name *

First

Last

Pre-School age & K-5 Grade Child is currently in *

Parent/Guardian Name *

Cell Phone Number *

Address *

City *

State *

Zip Code *

Parent/Guardian Email *

Child's Food Allergies *

Emergency Contact Name *

Emergency Contact Phone # *

Emergency Contact Relationship to Child *

Other Allergies or Medical Conditions *

May we have permission to photograph and/or video your child for use in church publications? *

Submit