NEW FAMILY PRE-REGISTRATION

Planned Visit Date

*

Parent Name(s)

*

Address

*

Email

*

This address will receive a confirmation email

Phone

*

CHILD INFORMATION

Child Name

*

Birth date

*

Grade

Allergies

*

I give Movement Church permission to use my child’s picture on their website, Facebook, or other promotional videos/pictures promoting Kids on the Move.

*

Yes No

ADDITIONAL CHILDREN

Child Name

Birth date

Grade

Allergies

Child Name

Birth date

Grade

Allergies

Child Name

Birth date

Grade

Allergies

Expected service to attend for the first time. 9:00AM 10:45AM

Description

Please fill out this form and click submit to pre-register your child(ren) for Kids On the Move (birth-grade 5).