Children's Ministry Registration Form

Glow Kids Registration Form

PLEASE COMPLETE A SEPARATE FORM FOR EACH CHILD REGISTERED.
Child's Name*

First NameLast Name
Primary Parent Contact's Name*

First NameLast Name
Primary Contact's Email Address*
Primary Contact Phone Number*

Area CodePhone Number
Additional Adult Authorized to Pick Up your Child

First NameLast Name
Secondary Email Address
Secondary Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Child's Date of Birth*

MonthDayYear
Any Allergies?
Any special needs or concerns you would like to share regarding your child?
Should be Empty:

Glow Kids Registration Form