Family Night Children's Registration

We are so excited to restart our Wednesday Night Family Ministry starting April 21 @7PM! Please complete one form for each child.

Child's Information

Name

*

Parent/Guardian #1 Name and Phone Number

*

Parent/Guardian #2 Name and Phone Number

Email

*

Birth Date

*

Allergies/Medical Conditions

Grade

*

Please select one option.

No Grade Pre-Kindergarten Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Graduated

School Name

Parents, May we use photos of your child on social media?

*

Please select one option.

Yes No

Anything else you want us to know?

Description

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