Danville- KidsLife Registration
Child's First Name
*
Child's Last Name
*
Date of Birth
*
School Grade
*
-- None --
Nursery/Pre-school
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Allergies
Are There Any Special Needs?
*
Yes
No
Gender
Male
Female
Guardian's First Name
Guardian's Last Name
Mobile Number (THIS IS HOW WE WILL CONTACT YOU IF NEEDED DURING SERVICE).
*
Email Address
*
Home Address
*
Home State
*
Home City
*
Home Zip Code
*
What date will you be attending?
Please select which service the child will be attending:
9AM
10:45AM
Do you give your consent for photography/video to be taken of your child during KidsLife at Life Church?
*
Yes
No
Remove
Add Another Person
Submit