Central Square Church child info & contact form
Please use this form to register your children and youth for Kid's Church and Youth Group at Central Square Church
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Parent/ Guardian Info
First and last name(s)
email(s)
phone number(s)
Emergency Contact Info
If emergency contact person is same as above please write "same"
First and last name
Phone
Relationship to child
Child 1
First & Last name
Birthdate
MM
/
DD
/
YYYY
Please list food restrictions, allergies, medications, medical needs, other notes:
Child 2
First & Last name
Birthdate
MM
/
DD
/
YYYY
Please list food restrictions, allergies, medications, medical needs, other notes:
Child 3
First & Last name
Birthdate
MM
/
DD
/
YYYY
Please list food restrictions, allergies, medications, medical needs, other notes:
Please check all that apply
Please check all that apply
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