Faith Kids Registration

[[[["field6","contains","Other"]],[["show_fields","field8"]],"and"]]

1 Step 1

CIA - Junior Church - Children's Church

Parent/Guardian 1

First Name

Last Name

Emaila valid email

Cell Phone Number

Birth DateChild's Birth Date

Relationship to child

Parent/Guardian 2

First Name

Last Name

Emaila valid email

Cell Phone Number

Birth DateChild's Birth Date

Relationship to child:

Address Information (Primary Residence of Child)

Home Address

City

State

Zip

Home Phone

1st Child's Information

First NameChild's First Name

Last Nameyour full name

Birth DateChild's Birth Date

GenderChild's Gender

GradeChild's Grade

SchoolChild's School

Allergies/Special Needs

2nd Child's Information

First NameChild's First Name

Last Nameyour full name

Birth DateChild's Birth Date

GenderChild's Gender

GradeChild's Grade

SchoolChild's School

Allergies/Special Needs

3rd Child's Information

First NameChild's First Name

Last Nameyour full name

Birth DateChild's Birth Date

GenderChild's Gender

GradeChild's Grade

SchoolChild's School

Allergies/Special Needs

PhotographyChildren's ministry leaders have permission to photograph/film the minor(s) designated above for any lawful purpose associated with this program.

YesNo