Online Registration Form

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Name 2

First Name

Last Name

Date

Phone

(###)

###

####

Phone 2

Second Contact

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Photo Consent

Do we (New Life Church) have permission to publish photos of your child(ren) on Facebook, Web, materials, etc.?

Yes

Child Name #1

First Name

Last Name

DOB

Gender

Grade

Allergies

If Applicable. Write "N/A" or "None" if child has no Allergies.

Child Name #2

First Name

Last Name

DOB

Gender

Grade

Allergies

Child Name #3

First Name

Last Name

DOB

Gender

Allergies

Grade

Child Name #4

First Name

Last Name

DOB

Gender

Grade

Allergies

Child Name #5

First Name

Last Name

DOB

Gender

Grade

Allergies

Child Name #6

First Name

Last Name

DOB

Gender

Grade

Allergies

Extra Kids

If you have more than the 6 kids for this form please list the extra kids in the box below. Child's name(s) -> DOB -> Gender -> Grade