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Plan your Visit - Registration Form
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* Indicates required question
Which service are you planning to attend?
*
St. Joe 9:30
St. Joe 11:00
Benton Heights 9:30
Benton Heights 11:00
Stevensville 9:30
Stevensville 11:00
Eau Claire 11:00
WOW on Wednesday at St. Joe
Required
Are you new to First Church?
*
Yes
No
Parent or Guardian #1 First Name
*
Your answer
Parent or Guardian #1 Last Name
*
Your answer
Parent or Guardian #1 Email
*
Your answer
Parent or Guardian #1 Address
*
Your answer
Parent or Guardian #1 Phone Number
*
Your answer
Parent or Guardian #2 First Name
Your answer
Parent or Guardian #2 Last Name
Your answer
Parent or Guardian #2 Email
Your answer
Parent or Guardian #2 Address (If different)
Your answer
Parent or Guardian #2 Phone Number
Your answer
Child's Full Name
*
Your answer
Child's Date of Birth
*
MM
/
DD
/
YYYY
Child's Address, if different from above
Your answer
Child's grade for 2023/2024 school year
*
Nursery
Preschool
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
Does this child have any Allergies/Special Needs/Medications?
Your answer
Do you have another child to register
*
Yes
No
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