CBC Kid's LIFE GROUP Registration: First time guests

Registration Form for First Time Guests for Kids Life Groups

Household Information
Household Name (Last Name)*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone*
Household Email Contact*
Parent/Guardian Information
Parent/Guardian Information*
First Name Last Name Relationship to Child(ren) Cell Phone Email

Click the plus sign to add another individual.
Child Information
Child Information*
Child First Name Child Last Name Gender DOB (MM/DD/YYYY) Grade Level/Age Allergies/Special Considerations

Click the plus sign for each additional child.
Additional Household Information
Others Authorized to Pick-Up Your Child
First Name Last Name Relationship to Child Phone Number

Click the plus sign to add another individual.
CAPTCHA

First Name	Last Name	Relationship to Child(ren)	Cell Phone	Email

Child First Name	Child Last Name	Gender	DOB (MM/DD/YYYY)	Grade Level/Age	Allergies/Special Considerations

First Name	Last Name	Relationship to Child	Phone Number

Household Information