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CHURCH PLANTING
GENERATION NEXT CHILDREN'S MINISTRIES
REGISTRATION FORM
Infants – Crawlers
Walkers
2's
3's – PreK
Kin. – 2nd
3rd – 5th
Please Check The Appropriate Age Level
*
Child's Info
Name:
Nickname:
Last
*
First
*
Middle
*
Male
Female
Birthday:
*
/
/
Grade:
Gender
*
Month
Day
Year
School Attending:
Allergies/Medical Conditions:
Special Instructions:
Parents' Info
Name(s):
*
Email Address:
*
Home Phone:
*
Cell Phone:
Home Address:
Street
*
City
*
State
*
Zip
*
Emergency Info
Adults authorized to pick up child in case of emergency:
Name:
*
Drivers License #:
*
Name:
Drivers License #:
Name:
Drivers License #:
Emergency Contact:
*
Phone #:
*
Human Verification:
*
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