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Creation Kidz Registration Form
Welcome to Creation Kidz. Please fill out this registration form for your family. Please include updated addresses and phone numbers whenever they change.
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* Indicates required question
First and Last Name
*
Your answer
Birthdate
Child's grade at time of registration
*
3 year old
PK
K
1
2
3
4
5
Gender given at birth.
*
Male
Female
Current Address
*
Your answer
Does your family attend Houghton Lake Wesleyan Church?
*
No
Yes
Allergies:
*
Your answer
Special needs:
*
Your answer
Parent's Name
*
Your answer
Parent's phone number
*
Your answer
Emergency Contact #1
*
Your answer
Emergency Contact #1's phone number
*
Your answer
Media Release (This allows your child to have their picture taken and used on social media or newspaper)
*
Yes
No
Parent's signature
*
Your answer
Submit
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