Child Registration Form

Parent/Guardian Name

Parent/Guardian Email

This address will receive a confirmation email

Parent/Guardian Phone

Parent/Guardian Address

Child's Name

Child's Birthdate

If registering more than one child, please list the name(s) and birthday(s) of each child in the box below

Medical Needs, Allergies, or Special Accommodations Necessary

Emergency Contact (Please include name and phone number)

May Central Christian Church use your child(ren)'s name and picture in promotion and publication material?

Yes No

Description

Please submit this for to register your child.
Thanks so much!