Community Christian Alliance Church Kids Ministries Registration Form
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1st Child's Name (Last Name) *
Your answer
Child's Grade in School *
Your answer
Child's Birthdate (mm/dd/yy) *
Your answer
What would you like to register for? *
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2nd Child's Name (First Name)
Your answer
2nd Child's Name (Last Name)
Your answer
Grade in School
Your answer
Birthdate (mm/dd/yy)
Your answer
What would you like to register for?
3rd Child's Name (First Name)
Your answer
3rd Child's Name (Last Name)
Your answer
Grade in School
Your answer
Birthdate (mm/dd/yy)
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What would you like to register for?
Father's Name (First and Last Name) *
Your answer
Mother's Name (First and Last Name) *
Your answer
Home Address *
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City/State/Zip *
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Home Phone Number *
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Primary Cell Phone Number *
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Email Address *
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Primary Language Spoken in the Home *
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Do you attend a church regularly? *
If Yes, Name of Church, denomination and how long?
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