Calvary Nexus Kids Church Registration 11:00am

Reason for completing registration form:(Required)

Number of Children(Required)

Please enter a number from 0 to 5.

Child 1 - Information

Legal Name(Required)

First Last

Nickname(Required)

Date of Birth(Required)

Grade(Required)

Gender(Required)

Does your child have an IEP?(Required)

List any allergies or special conditions(Required)

Child 2 - Information

Legal Name(Required)

First Last

Nickname(Required)

Date of Birth(Required)

Grade(Required)

Gender(Required)

Does your child have an IEP?(Required)

List any allergies or special conditions(Required)

Child 3 - Information

Legal Name(Required)

First Last

Nickname(Required)

Date of Birth(Required)

Grade(Required)

Gender(Required)

Does your child have an IEP?(Required)

List any allergies or special conditions(Required)

Child 4 - Information

Legal Name(Required)

First Last

Nickname(Required)

Date of Birth(Required)

Grade(Required)

Gender(Required)

Does your child have an IEP?(Required)

List any allergies or special conditions(Required)

Child 5 - Information

Legal Name(Required)

First Last

Nickname(Required)

Date of Birth(Required)

Grade(Required)

Gender(Required)

Does your child have an IEP?(Required)

List any allergies or special conditions(Required)

Guardian 1

Relationship(Required)

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Guardian 2

Relationship(Required)

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Other Authorized Guardians

Person(s) who are 18 years or older that are authorized to sign my child(ren) in/out of class

Number of Additional Guardians(Required)

Please enter a number from 0 to 3.

Name(Required)

First Last

Relationship(Required)

Name(Required)

First Last

Relationship(Required)

Name(Required)

First Last

Relationship(Required)

Unauthorized Guardians

Person(s) who are 18 years or older that are not authorized to sign my child(ren) in/out of class (If a birth parent is listed here, legal documentation is required.)

Number of Unauthorized Guardians(Required)

Please enter a number from 0 to 3.

Name(Required)

First Last

Relationship(Required)

Name(Required)

First Last

Relationship(Required)

Name(Required)

First Last

Relationship(Required)

File

Max. file size: 50 MB.

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Children's Ministry

Nexus Kids