Kid’s Christmas Party

REGISTER HERE

One Child Per Registration Please.
Have Multiple Children? No Problem! You will be given the option to add additional children on the next screen.

Hurry — Space is limited!

Registration Information

Child's Name

Parent's Name

Address

Phone Number

Person(s) Authorized to Pick Up Child

How Did You Hear About This Event? This helps us focus on how best to advertise future events.

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

Medical Information

Medical Information Please list any allergies (food, bees, etc.) and/or physical limitations that your child may have as well as any medications we need to be aware of to treat them.

Photo Release

Photo Release Do you grant permission for Country Road Bible Church to use pictures of my child on their website for informational or promotional purposes.

Signature

Signature By typing your full name, you are digitally signing this document and declaring that all the above information is correct.