Kids Unlimited CHILD Registration - CC
Please start with
PARENT
information at the top of the form and then you will fill out child information.
* First Name
* Last Name
* Are you a member of Central Baptist Church?
Select one
Yes
No
* Email
* Mobile Phone
Entering your mobile phone will opt you in for receiving occasional updates (freq may vary) via text message. Reply STOP at any time to opt out. Reply HELP for more information. Message and data rates may apply.
Privacy Policy
* Address
* City
* State/Province
* Zip/Postal Code
* Child's Name
* Gender
Select one
Male
Female
* Child's Birth Date
* Grade (age group)
Select one
3 year old
4 year old
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
* List Child's Allergies
* Is there any educational and/or medical diagnosis of which we need to be aware of? Please explain
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