Family Ministry Parent/Guardian Info
We're excited to welcome your child to our Children and Student programs!
Please enter your contact information below. If you would like to add a second parent/guardian, click
ADD A PERSON
.
Click
CONTINUE
to register your child.
Our staff are happy to answer any questions:
Grades 1-4 Director:
ldeboer@covenantpalmbay.org
Grades 5-8 Director:
jmorse@
covenantpalmbay.org
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Parent/Guardian
First Name
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Parent/Guardian
Last Name
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Parent/Guardian
Email
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Parent/Guardian
Mobile Phone
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If new or different address, fill out the following:
- Allows parents to skip the registration field(s) that are still current
Parent/Guardian
Address
Parent/Guardian
Address 2 (Apt/Suite # etc.)
Parent/Guardian
City
Parent/Guardian
State/Province
Parent/Guardian
Zip/Postal Code
Medical Insurance Information
- ...
Parent/Guardian
Health Insurance carrier name & phone #
Parent/Guardian
Health Insurance Policy #
Parent/Guardian
Health Insurance Group #
Liability Release Form
View Waiver
- Please read before accepting.
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Parent/Guardian
Liability Form Acceptance
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Parent/Guardian
Child's Emergency Contact (in addition to parent/guardian) include name, phone # and relationship
Add Another Parent/Guardian
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