Registration Form

First Child's Gender (required)
MaleFemale
First Child's First Name (required)

First Child's Last Name (required)

First Child's Date of Birth (required)

First Child's Grade (required)
InfantPre-K (3-5 years old)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade
Parent's Name (required)

Child's Street Address (required)

Child's City (required)

Child's Zip Code (required)

Child's Home Church (if any)

Home Phone (required)

Cell Phone (required)

Your Email (required)
Registration Confirmation will be sent to this email address

Emergency Contact (Other than Parents)
- Name and Phone Number (required)

Register Additional Children in Same Household:
Gender, Name, Birth Date, Grade

Questions or Comments