Christian Ed Registration

We invite you to join us for our Christian Education ministry on Sunday mornings and Wednesday evenings.
In order to provide a safe and secure environment, we ask for some information about your family.
Please fill out the form below.
There will be a final permission form, including photo and travel permission that needs to be signed on the first day of your child's involvement in our ministry.

Parent Name

Parents or parent with primary custody

Address

Including city, state and zip code

Home/Landline phone

Cell Phone

Include name of parent

Primary email

Email checked most often!

Second Cell phone

Include name of parent

Second email

Child 1

Child 1 Date of Birth

Child 1 School Grade/Location

Child 2 name

Child 2 Date of Birth

Child 2 School Grade/Location

Child 3 name

Child 3 Date of Birth

Child 3 School Grade/Location

Additional Children

Include same information as above

Allergies and/or other conditions we need to be aware of

Emergency Contact

Name, relationship and phone numbers of a contact not residing in the same home.