Father's Info (Name, Phone, Address, City/State/Zip Code, Email)

Mother's Info (Name, Phone, Address, City/State/Zip Code, Email)

Child 1 Info (Name, Grade, School, Birthdate, Allergies/Special Needs)

Child 2 Info (Name, Grade, School, Birthdate, Allergies/Special Needs)

Child 3 Info (Name, Grade, School, Birthdate, Allergies/Special Needs)

Child 4 Info (Name, Grade, School, Birthdate, Allergies/Special Needs)

Child 5 Info (Name, Grade, School, Birthdate, Allergies/Special Needs)

Emergency Contact (Name, Phone)

Please list all who are authorized to drop off or pick up your child(ren): (Name, Relationship to child(ren), Phone)

Do you want to be added to the 'Kidz for Christ' Facebook group?

Yes, sign me up

No, thank you

Any additional information we should know?

NW Indiana District Church of the Nazarene

Child Registraion