KidMin! Online Registration Form
Registration for KidMin! at Glory Baptist Church - school year 2019-20.

Program starts September 11th @ 6:30 p.m. 2019!

Family meal provided from 6:00-6:30 p.m. in our lower level.

Please register each child separately!
Email address *
Student Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip *
Your answer
Gender *
Required
DOB (MM/DD/YY) *
Your answer
Grade for 2019-20 school year *
Best Phone Number to Reach a Parent/Guardian *
Your answer
Mother's (or guardian's) Name
Your answer
Mother's Cell (or Home Phone)
Your answer
Mother's Email Address
Your answer
Father's (or guardian's) Name
Your answer
Father's Cell (or Home Phone)
Your answer
Father's Email Address
Your answer
Who does child live with primarily? *
If other, please list who
Your answer
If Mom's/Dad's address or home phone is different, type it here.
Your answer
Please list any food allergies and/or medical conditions we need to be aware of.
Your answer
Does your family attend church? If so, where?
Your answer
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