New Life Kids Registration

PARENT/GUARDIAN INFORMATION
Church Attendance *
Dad's Information

First Name Last Name
Phone Number
Texting
Mom's Information

First Name Last Name
Phone Number
Texting

Address

Street Address
Street Address Line 2
City	State
Zip Code	Country

Other Guardian (If child is brought by someone other than their parents.)
Other Guardian's Name

First Name Last Name
Phone Number
Texting
Relationship to Child(ren)

CHILD INFORMATION
Child's Name *

First Name Last Name
Gender *
Birthday *

/ Month / Day Year
Age/Grade *
Allergies/Special Needs
Type a question

Add Another Child
Child Information
Child's Name *

First Name Last Name
Gender *
Birthday *

/ Month / Day Year
Age/Grade *
Allergies/Special Needs
Type a question

Add Another Child
Child Information
Child's Name *

First Name Last Name
Gender *
Birthday *

/ Month / Day Year
Age/Grade *
Allergies/Special Needs
Type a question

Add Another Child
Child Information
Child's Name *

First Name Last Name
Gender *
Birthday *

/ Month / Day Year
Age/Grade *
Allergies/Special Needs
Email
Email associated with registration
Should be Empty:

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