What do we need to know about Child #1 in order to best serve their needs? *
Your answer
Child #2 Name
Your answer
Child #2 Birth date
MM
/
DD
/
YYYY
Child #2 Grade in School/Homeschool
Your answer
What do we need to know about Child #2 in order to best serve their needs?
Your answer
Child #3 Name
Your answer
Child #3 Birth date
MM
/
DD
/
YYYY
Child #3 Grade in School/Homeschool
Your answer
What do we need to know about Child #3 in order to best serve their needs?
Your answer
Child #4 Name
Your answer
Child #4 Birth date
MM
/
DD
/
YYYY
Child #4 Grade in School/Homeschool
Your answer
What do we need to know about Child #4 in order to best serve their needs?
Your answer
Parent/Caregiver #1 Name *
Your answer
Parent/Caregiver #1 Phone *
Your answer
Parent/Caregiver #1 Email
Your answer
Parent/Caregiver #2 Name
Your answer
Parent/Caregiver #2 Phone
Your answer
Parent/Caregiver #2 Email
Your answer
Contact information for other caregivers who might be responsible adults during online programming: name, email, relationship to child(ren).
Your answer
Each month, packets will be available for some of our classes to either receive by mail or pick up curbside at the church. Please include your complete mailing address here so we can send materials as necessary. *
Your answer
Photo/Media Permission (Please note we will never identify children online unless specifically requested by parent/guardian.) *