LifeKids Registration

Please fill out this form and click submit.

Today's Date

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First Name of Applicant Parent/Guardian

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Last Name of Applicant Parent/Guardian

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Main Email

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This address will receive a confirmation email

Main Phone

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Address

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Child's First Name

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Child's Last Name

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Child's Date of Birth

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Child's Gender

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Please select one option.

Male Female

Child's Grade

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Please select one option.

Preschool (12-36 months) JK SK 1 2 3 4

Child's Allergies/Medical Conditions

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I consent to the use of photos or video of my child for promoting/celebrating Family Ministry activities.

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Please select one option.

Yes No

Description

Please fill out this form and click submit.

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