Kids Ministry Registration

Required fields *

Child Name *

Birth Date *

Age *

Grade *

Names of Siblings Attending

Address *

Parent's Name - primary contact *

Home Phone *

Work/Cell Phone

Parent's Email *

Parent's Name - secondary contact

Home Phone

Work/Cell Phone

Parent's Email

Emergency Contact and Phone *

Allergy/Health Conditions and “I permit my child’s name and food allergy to be posted for Kid's Ministry staff members to see. *
YesNoN/A

My child has my permission to attend and participate in Kids Ministry program. (electronic parent signature and date) *