MC3 Church Children's Registration Form
Please complete this form to preregister your child for our database. If you have any questions, contact Jim Barber at barber@mc3.life.
Child's Name *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Age
Your answer
School
Your answer
Grade *
Your answer
Preferred Emergency Contact Number *
Your answer
Mother's Name *
Your answer
Mother's Cell Phone Number *
Your answer
Mother's Email Address *
Your answer
Father's Name *
Your answer
Father's Cell Phone Number *
Your answer
Father's Email Address *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Allergies/Special Needs
Your answer
Guest of
Your answer
Check box if first-time visitor
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