Child's First Name:                                                  Child's Last Name: 

Grade Completed:                                                     Childs  Birth date   

Parent's Name:            

Address:                           City:       Zip: 

Phone:                                                                             Alternate Phone: 

Email Address:        

Emergency Contact:                                             Emergency Phone:    

Medical Problems:    

I am willing to help in the following area(s):

I would be willing to work on the following day(s):

Please only complete this section if you are not the child's parent

Name:         

Address:     

Zip:              

Phone:         

Additional Information (if needed)

Please Note:  If after pressing submit, you do not see a "Thank You" page, your registration did not go through.   We are very sorry for any inconvenience.  Sometimes there may be technical issues, so please be patient.  If you are not certain that your child has been registered, please call the church office at (864) 224-5909.