Lafayette-KidsLife Registration

Please fill out ALL fields for first child...for subsequent children name and date of birth is sufficient.

Child's First Name *

Child's Last Name *

Child's Age *

Allergies

Date of Birth *

Tip: Child's Date of Birth

Gender *

Parent/Guardian First Name

Parent/Guardian Last Name

Email Address

Phone Number

Home Address

Home City

Home State

Home Zip Code

Please select what day you will be attending:

Please select one or both services you will be attending