UNITED CHURCH KIDS PRE-REGISTRATION FORM

Name

First Name

Last Name

Email Address

Mobile Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Spouse Name

Spouse Number

Spouse Email

Notes

Any helpful family information: Allergies, Custody, Questions, etc.

Child #1 Name and Date of Birth

Child #2 Name and Date of Birth

Child #3 Name and Date of Birth

Child #4 Name and Date of Birth

Child #5 Name and Date of Birth