Program Registration 2017/2018
Please fill out one form for each person in your household under the age of 18. This form will be used for all Children and Youth Programs at King's Grant Presbyterian Church.
General Information
Full Name of Child/Youth
Your answer
Allergies/Special Needs (Please specify reaction to allergy)
Your answer
Child/Youth Birthday
MM
/
DD
/
YYYY
School Grade (for the 2017/2018 School Year)
School Attending in 2017/2018
Your answer
Name of Parent/Guardian
Your answer
Relation to Child/Youth
Your answer
Parent/Guardian Contact E-Mail
Your answer
Youth Contact E-Mail
Your answer
Home Address
Your answer
Parent Cell Phone Number
Your answer
Parent Home Phone Number
Your answer
Youth/Child Cell Phone Number
Your answer
What else do we need to know to best minister to your child?
Your answer
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