KidZone Registration
Thanks for your interest in Southtown's Kid's Ministry! Please fill this out so we are best able to serve you and your child!
Basic Information
Child's Name
*
Parent/Guardian Name
*
Address
*
--
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
Cell Phone
*
Parent Email
*
This address will receive a confirmation email
Age Information
Current Age (must be 4 or older)
*
Child's Birthday MM/DD/YY
*
Grade in School
*
Please select one option.
PK
K
1st
2nd
3rd
4th
5th
6th
Select Option
PK
K
1st
2nd
3rd
4th
5th
6th
Anything Else We Should Know?
Please list any medical or other information we need to know (please include any allergies or known behavioral issues)
Emergency Contact (other than parent/guardian listed above)
Emergency Contact Name
*
Emergency Contact Phone Number
*
Dismissal Information
Who may pick your child up? Separate names with a comma
*
Other Information
Does your child attend Sunday School?
*
Please select all that apply.
Yes
No
If so, where?
Is your child an invited guest of a specific person?
*
Please select all that apply.
Yes
No
If so, who?
May we have permission to photograph your child?
*
Please select all that apply.
Yes
No
If we can photograph your child, may we have permission to use your child's photograph for the purpose of promotion or on our church social media?
*
Please select all that apply.
Yes
No
Submit
Description
Thanks for your interest in Southtown's Kid's Ministry! Please fill this out so we are best able to serve you and your child!
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