FOR AGES 3 – 6TH GRADE (MUST HAVE TURNED 3 BY SEPT. 1ST, 2016)

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PLEASE COMPLETE A REGISTRATION FOR EACH CHILD ~ THANK YOU.

 

Child's Name (required)

Today's Date (required)

Gender (required)
MaleFemale

Age (required)

Birthdate (required)

2017 Grade Completed (required)
K1st2nd3rd4th5th6th

If your child is 4 years old, will he/she be attending Kindergarten in the Fall?
yesnoN/A

Address (required)

City (required)

State (required)

Zip (required)

Does your family attend church regularly?
yesno

Parent Name (required)

Home Phone (required)

Emergency Phone (required)

Your Email (required)

Allergies/Concerns

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KIDS’ CLUB

IS ON WEDNESDAY EVENINGS FROM JULY 12 – AUGUST 23, FROM 7:00 – 8:15 PM.