Children's Ministry New Family
Please fill out this form and click submit.
Parent Information
Parent/Guardian #1's Name
Parent/Guardian #1's Email
Parent/Guardian #1's Cell Phone
Parent/Guardian #2's Name
Parent/Guardian #2's Email
Parent/Guardian #2's Cell Phone
Address
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child #1
Name
*
Birthday
*
Gender
*
Please select one option.
M
F
Grade in School
*
Please select one option.
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Not in school yet.
Allergies/Medical Concerns
*
Child #2
Name
Birthday
Gender
Please select one option.
M
F
Grade in School
Please select one option.
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Not in school yet.
Allergies/Medical Concerns
Child #3
Name
Birthday
Gender
Please select one option.
M
F
Grade in School
Please select one option.
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Not in school yet.
Allergies/Medical Concerns
Child #4
Name
Birthday
Gender
Please select one option.
M
F
Grade in School
Please select one option.
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Not in school yet.
Allergies/Medical Concerns
Child #5
Name
Birthday
Gender
Please select one option.
M
F
Grade in School
Please select one option.
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Not in school yet.
Allergies/Medical Concerns
Emergency Contact Information
Name
Relationship to child(ren)
Cell Phone
Other
Is there anything else you would like us to know?
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Description
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