Registration Form

(One Per Child)

Child's name:

Child's gender:

Child's age:

Date of birth:

Last grade completed:

Name of parent(s):

Street address:

City/State/Zip code:

Home telephone:

Parent/caregiver's cell phone:

Email address:

Home church:

Alergies or other medical conditions:

In case of emergency, contact name:

Their phone number:

Their relationship to the child:

Permission to post photographs of child:

Pictures are used on our App, website and facebook page for NPAG kidszone events.