CHILD REGISTRATION FORM
Please fill out this form and click submit.
Parent/Guardian Name 1
*
Phone
*
Parent/Guardian Name 2
Additional Contact Phone
Address
*
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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
Email
Child Name 1
*
Date of Birth
*
Grade
Allergies/Special Needs
Child Name 2
Date of Birth
Grade
Allergies/Special Needs
Child Name 3
Date of Birth
Grade
Allergies/Special Needs
May we use pictures that may be taken of your child(ren) while participating in our Children's Ministry on our website or social media?
*
Please select one option.
Yes, I grant permission.
No, I do not grant permission.
Select Option
Yes, I grant permission.
No, I do not grant permission.
By signing, I hereby absolve New Life Alliance Church of any responsibility to me or the child(ren) related to the child(ren)'s participation in New Life Alliance Church and its Children's Ministry. I understand that security cameras are in use for safety purposes.
*
Please select all that apply.
Parent/Guardian Signature 1
Parent/Guardian Signature 2
Date
Submit
Description
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