KidMin! Online Registration Form

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Registration for KidMin! at Glory Baptist Church - school year 2022-23.

Program starts September 14 @ 6:30 p.m. 2022!

Family meal provided from 6:00-6:30 p.m. in our lower level.

Please register each child separately!

Email *

Student Name *

Street Address *

City *

Zip *

Gender *

Male

Female

Required

DOB (MM/DD/YY) *

Grade for 2022-23 school year *

Best Phone Number to Reach a Parent/Guardian *

Mother's (or guardian's) Name

Mother's Cell (or Home Phone)

Mother's Email Address

Father's (or guardian's) Name

Father's Cell (or Home Phone)

Father's Email Address

Who does child live with primarily? *

If other, please list who

If Mom's/Dad's address or home phone is different, type it here.

Please list any food allergies and/or medical conditions we need to be aware of.

Does your family attend church other than Glory Baptist Church? If so, where?

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