KidZONE Family Registration

Welcome to the KidZONE!
Please fill in the form below to register your child(ren) in the KidZONE. All information is kept confidential and used to provide the best possible care for your child while at Christ Community Church. Please do not hesitate to email with any questions you may have.

Household Last Name:
*
Main contact number (XXX-XXX-XXXX)
*
Custodial Parent#1 Name (First Last)
*
Custodial Parent #1 Cell Phone (XXX-XXX-XXXX)
*
Custodial Parent #1 Email Address:
Custodial Parent #2Name (First Last)
Custodial Parent #2 Cell Phone (XXX-XXX-XXXX)
Custodial Parent #2 Email Address:

Mailing Address:
*
City:
*
State:
*
Zip Code:
*

Child #1 Name (First Last)
*
Child #1 Gender (M/F)
*
Child #1 Birthdate: (MM/DD/YY)
*
Child #1 Grade (if applicable):
*

Child #2 Name (First Last)
Child #2 Gender (M/F)
Child #2 Birthdate: (MM/DD/YY)
Child #2 Grade (if applicable)

Child #3 Name (First Last)
Child #3 Gender (M/F)
Child #3 Birthdate: (MM/DDD/YY)
Child #3 Grade (if applicable):

Child #4 Name (First Last)
Child #4 Gender (M/F)
Child #4 Birthdate (MM/DD/YY)
Child #4 Grade (if applicable):

Allergies or medical conditions to be aware of:
Security code:
*
Do not enter anything in this field:

* indicates a required field