MC Kids 2018-19 Registration
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Nickname
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Birthday: *
MM
/
DD
/
YYYY
Age: *
Your answer
Grade: *
T-Shirt Size: *
Street Address: *
Your answer
City: *
Your answer
Zip: *
Your answer
Parent / Guardian Name: *
Your answer
Cell Phone: *
Your answer
Other Phone:
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Email Address: *
Your answer
Emergency Contact 1 Name and Phone Number: *
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Emergency Contact 2 Name and Phone Number: *
Your answer
Known Allergies or Health Issues: *
Your answer
By checking this box, I acknowledge the above information is correct, and I give permission for my child to participate in MC Kids at Mountain Creek Baptist Church: *
Required
During MC Kids, photos are taken for MC Kids events, bulletin boards, etc. at Mountain Creek, as well as occasional promotional photos on social media. *
Required
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