MissionKids Registration

* Indicates a REQUIRED field.

Child Information
How Many Children Are You Registering?*
Child 1 Name
First Last
Date of Birth
MM slash DD slash YYYY
Which class will your child attend?
Allergy or Medical Conditions?
Child 2 Name
First Last
Child 2 Name
First Last
Child 2 Name
First Last
Date of Birth
MM slash DD slash YYYY
Which class will your child attend?
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Current Grade
Allergy or Medical Conditions?
Child 3 Name
First Last
Child 3 Name
First Last
Date of Birth
MM slash DD slash YYYY
Which class will your child attend?
This field is hidden when viewing the form
Current Grade
Allergy or Medical Conditions?
Child 4 Name
First Last
Date of Birth
MM slash DD slash YYYY
Which class will your child attend?
This field is hidden when viewing the form
Current Grade
Allergy or Medical Conditions?
Parent Information
Parent/Guardian Name*
First Last
Address*
Street Address City State ZIP Code
Parent/Guardian Email Address*
Parent/Guardian Primary Phone Number*
Emergency Contact Name*
First Last
Emergency Contact Phone Number*
Anything Else We Need To Know?
Additional Person Authorized to Pick Up/Check Out Child
First Last
Contact Number for Authorized Person
Alternate pick-up person may be required to provide photo ID if requested.
Permission To Use Photos*
Please indicate your permission for your family members' image to be used as described below by completing this section: In order to protect our children and youth, we use photos and video taped images without names in our print, broadcast, and digital publicity - for example, in the Focus newsletter, on our website, on bulletin boards within the Church building, and in other communications media.
- I give permission for my child(ren)'s image to be used without names as described above
- I do NOT give permission
Comments
This field is for validation purposes and should be left unchanged.

MissionKids Registration

Child Information

Parent Information