CHILDREN'S MINISTRY ENROLLMENT FORM

Please fill out all information.

 

Child/Youth Information

Name:   

Date of Birth (mm/dd/yyyy): 

Nursery or Current Grade:  

Parent/Guardian Information

Name:  

Address:  

Home Phone Number:  

Cell Number 1:       Cell Number 2:  

Email Address 1:    Email Address 2: 

Allergies:                   

Other (special needs, interests, hobbies):   

 

This form will be submitted upon 'clicking' on the submit button.  Any questions, please contact Jen Perry at clifandjenperry@gmail.com or 609-896-9090.