City Kids Registration Form
Filling out this form will help us be ready when you bring your child to City Kids for the first time!
Child One
Child's Name
Child's Birthday
Please list any allergies:
Optional
Child Two
Child's Name
Child's Birthday
Optional
Please list any allergies:
Optional
Child Three
Child's Name
Child's Birthday
Optional
Please list any allergies:
Optional
Child Four
Child's Name
Child's Birthday
Optional
Please list any allergies:
Optional
Child Five
Child's Name
Child's Birthday
Optional
Please list any allergies:
Optional
Household Information
Parent or guardian:
Email
This address will receive a confirmation email
Phone
Does this phone number receive text messages?
Please select one option.
Yes
No
Parent or guardian:
Email
Optional
Phone
Optional
Does this phone number recieve text messages?
Optional
Please select one option.
Yes
No
Address
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
I would like more information about volunteering in City kids.
Optional
Please select one option.
Yes
No
I would like more information about infant baptism.
Optional
Please select one option.
Yes
No
Is there anything else you'd like us to know when caring for your child(ren)?
Optional
Submit
Description
Filling out this form will help us be ready when you bring your child to City Kids for the first time!
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