Kid Connection Registration Form
Name of Parent(s) or Guardians (First and Last) *
Full Address of Child(ren) *
Preferred Sunday Contact Number *
Father's email:
Mother's email:
Who does the child live with? *
Is the child attending with someone other than parents/legal guardian? *
If yes to the above, please list the following: name of who the child(ren) are attending with, relationship to the child, phone number, address, and room location.
Name of Child (First and Last) *
Gender of Child *
Grade of Child *
Child's Date of Birth (mm/dd/yyyy) *
Please include month, day, and year.
School Child Attends
Does this child have any known allergies? *
If yes to above, please list all allergies or food sensitivities of the child:
Does this child have a diagnosis, medical condition or learning difference? *
If yes to above, list what areas the child needs assistance with (you may be contacted to discuss further):
Do you have another child to add? *
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