BLAST Kids Ministry Registration Form
Parent/Guardian Information
Parent/Guardian First Name
*
Parent/Guardian Last Name
*
Are you a member of LFCC?
Yes
No
Email Address
*
Mobile Number
*
Child Information
First Name
*
Last Name
*
Date of Birth
*
Gender
*
Male
Female
School Grade
*
-- None --
Infant/Toddler (0-2 yo)
Pre-K (3-5 yo)
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Please check any that apply
1. Allergies (please specify)
2. Special Needs
*SN: Y*
3. Potty Training
℗
4. Photo consent
Photo: Y
5. Communion
Communion: Y
Please fill this out if another person should be contacted in the event of an emergency today.
6. Contact person for today
7. Contact person's mobile number
8. Additional Notes (hobbies, interests, medical concerns, favorite color, etc.)
Remove
Add another child
Submit
