Children’s Church Registration

Online Registration Agreement*
PLEASE READ THIS AGREEMENT CAREFULLY AS USE OF THE SERVICE CONSTITUTES ACCEPTANCE OF THESE TERMS AND CONDITIONS. IF YOU DO NOT AGREE, DO NOT REGISTER. Online registration for this event may only be completed by an adult eighteen years old or older. The registration of a child under thirteen years old must be completed by that child’s parent or legal guardian.
- I agree
- I do not agree
Child's Name*
First Last
Child's Age*
Child Birthdate*
MM slash DD slash YYYY
Child Last grade completed*
Parent/Guardian Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian Primary Phone*
Parent/Guardian Secondary Phone
Parent/Guardian Email*
Allergies/Health information/Special Needs
Please provide us the appropriate information. Leave blank if not applicable.
Emergency Contact #1*
First Last
Emergency Contact #1 Phone*
Relationship to child
May we photograph your child? Images may be used in end of program video/on our church website.*
- Yes
- No
If you are a member/regular attender at a different church, where do you attend?
Name of Adult who will be picking up child*
Phone
This field is for validation purposes and should be left unchanged.

CAMPUS LOCATION

SERVICE TIMES

Sundays
Sunday School: 9:45 AM
Worship: 11:00 AM

Wednesdays
Bible Study: 7:00 PM