Kids World Midweek Registration

Fields marked with (*) are required

(1) Parent/Guardian Full Name	*
(2) Parent/Guardian Full Name

Address	*	City* StateZip

E-mail Address	*
Phone (1)	*	Home Cell Work
Phone (2)		Home Cell Work
Phone (3)		Home Cell Work

Child 1
First Name	*
Last Name	*
Gender	*	Male Female
Birthdate	*	**
Age	*
Grade	*
Shirt Size	*
Specific Needs (allergies, special needs, etc.)

Child 2
First Name
Last Name
Gender		Male Female
Birthdate
Age
Grade
Shirt Size
Specific Needs (allergies, special needs, etc.)

Child 3
First Name
Last Name
Gender		Male Female
Birthdate
Age
Grade
Shirt Size
Specific Needs (allergies, special needs, etc.)

Release Form
I acknowledge that my child's picture may be taken at church functions and for his/her attendance badge. I hereby consent to the use of my child's pictures on the website, slideshow, name badge, or any other way by Jamul Community Church.
Please enter your name here to sign this release*