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

Click the plus sign for each additional child.

Do you give permission for your child(ren) to visit our Calming Room?*
CBC Kids has a Calming Room to use if needed. Tours are welcome so please ask when you attend and we will gladly walk you and your child(ren) through our Calming Room.
- Yes, please allow my child(ren) to visit the Calming Room with a volunteer if needed!
- No, I’d rather my child(ren) not visit the Calming Room. Please come get me to help my child if they are in need.
- I prefer to be the one to take my child to the Calming Room. Please come get me if my child is in need. (Please note, this creates a delay in getting them to the calming environment.)
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.

Household Information