PAC Kids Registration

PAC KIDS REGISTRATION

PAC Kids includes Preschool - 5th grade. Please fill out the form below to register kids for classes for the 2021-2022 season. We look forward to seeing your family at Plymouth Alliance Church!

PAC KIDS REGISTRATION 2021-2022

Parent/Guardian Information:

* Indicates required field

Parent/Guardian 1 Name *

First

Last

Parent/Guardian 2 Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Is this a cell number? *

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

*Please Note: For little ones just entering the program, please be sure they are potty trained prior to sending them.

Child 1:

Child 1 Name *

First

Last

Child 1 Date of Birth *

Child 1 Age *

Child 1 Grade *

Male or Female? *

Child 1 Allergies or Conditions *

Child 2:

Child 2 Name *

First

Last

Child 2 Date of Birth *

Child 2 Age *

Child 2 Grade *

Male or Female? *

Child 2 Allergies or Conditions *

Child 3:

Child 3 Name *

First

Last

Child 3 Date of Birth *

Child 3 Age *

Child 3 Grade *

Male or Female? *

Child 3 Allergies or Conditions *

Child 4:

Child 4 Name *

First

Last

Child 4 Date of Birth *

Child 4 Age *

Child 4 Grade *

Male or Female? *

Child 4 Allergies or Conditions *

Which Class(es) Will Your Child(ren) Attend?

My Child(ren) Will Attend: *

ROOTED KIDS on Sunday Morning during 10:15 am service (Preschool-4th grade) JOURNEY on Wednesday Nights 6-7:30 pm (Preschool-5th grade)

Who is authorized to pick up your child?

Authorized Pick Up Name #1 *

First

Last

Authorized Pick Up Name #2 *

First

Last

Authorized Pick Up Name #3 *

First

Last

May your child(ren) or family be photographed and may the picture appear in church articles or on our website (no names will be attached with the picture)? *

Other Comment(s) *

Submit