KID’S CHURCH REGISTRATION #LovedAndSafe We can’t wait to begin to teach your child about God’s love and all the awesome stories from the Bible! Please register your child below. Note: Please use one form per child. Please enable JavaScript in your browser to complete this form. – Step 1 of 3Child's InformationName *FirstLastGrade *If registering in summer, please list the grade your child will be entering. If child is not yet in school, mark “N/A”.Birthday *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's Allergies/Medical Instructions/Special NotesNextParent/Guardian InformationName *Email *Address *Address Line 1Address Line 2CityPennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *NextEmergency ContactName *Phone Number *Relationship With ChildMessageSubmit Please enable JavaScript in your browser to complete this form. - Step 1 of 3Child's InformationName *FirstLastGrade *If registering in summer, please list the grade your child will be entering. If child is not yet in school, mark "N/A".Birthday *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Child's Allergies/Medical Instructions/Special NotesNextParent/Guardian InformationName *Email *Address *Address Line 1Address Line 2CityPennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *NextEmergency ContactName *Phone Number *Relationship With ChildWebsiteSubmit Share this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to email a link to a friend (Opens in new window)Click to print (Opens in new window)
