Children's Ministry Registration 2018-2019
Family Name
Your answer
Father/Guardian First Name
Your answer
Father/Guardian Last Name (if different from family name)
Your answer
Email Address
Your answer
Cell Phone Number
Your answer
Comments
Your answer
Mother/Guardian First Name
Your answer
Mother/Guardian Last Name (if different from family name)
Your answer
Email Address
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Cell Phone Number
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Comments
Your answer
Home Address (line 1)
Your answer
Home Address (line 2)
Your answer
City
Your answer
State
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Zip
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Home Phone Number
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Child (1) First Name
Your answer
Child (1) Last Name (if different from family name)
Your answer
Date of Birth (MM/DD/YYYY)
Your answer
M/F
Your answer
Allergies
Your answer
Comments
Your answer
Grade
Your answer
Child (2) First Name
Your answer
Child (2) Last Name (if different from family name)
Your answer
Date of Birth (MM/DD/YYYY)
Your answer
M/F
Your answer
Allergies
Your answer
Comments
Your answer
Grade
Your answer
Child (3) First Name
Your answer
Child (3) Last Name (if different from family name)
Your answer
Date of Birth (MM/DD/YYYY)
Your answer
M/F
Your answer
Allergies
Your answer
Comments
Your answer
Grade
Your answer
Child (4) First Name
Your answer
Child (4) Last Name (if different from family name)
Your answer
Date of Birth (MM/DD/YYYY)
Your answer
M/F
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Allergies
Your answer
Comments
Your answer
Grade
Your answer
Authorized Caretaker Name
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Relation to Family
Cell Phone Number
Your answer
Email Address
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