Lake Cooley Kids at The Mill Midweek Registration
Wednesday Nights are exciting at Church at The Mill. Each week kids and students gather together to grow spiritually, have fun, serve others, and worship Jesus! Dinner will be provide for Kids and Volunteers. Preschool parents must stay on campus during Midweek.
Parent's Name
*
First Name
Last Name
Parent's Name 2
First Name
Last Name
Please list both parents if applicable.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent's Cell:
*
Parent's Email:
*
example@example.com
Please list your Kid(s) Name, Age AND Grade.
Child 1
*
First Name
Last Name
Gender
*
Female
Male
Date of Birth
*
-
Month
-
Day
Year
Date
Age/Grade
*
Please Select
Nursery
1 Yr
2 Yr
3 Yr
4 Yr
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergy or Medical Conditions
Please list/describe any allergies or medical conditions.
Do we have permission to photograph or video your child(ren) for promotional use?
*
Please Select
Yes
NO PHOTO
If the answer is yes for all children, mark yes. here. Otherwise specify which child cannot be photographed below.
Child 2
First Name
Last Name
Gender
Female
Male
Date of Birth
-
Month
-
Day
Year
Date
Age/Grade
Please Select
Nursery
1 Yr
2 Yr
3 Yr
4 Yr
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergy or Medical Conditions
Please list/describe any allergies or medical conditions.
Do we have permission to photograph or video your child for promotional use?
Please Select
Yes
NO PHOTO
Child 3
First Name
Last Name
Gender
Female
Male
Date of Birth
-
Month
-
Day
Year
Date
Age/Grade
Please Select
Nursery
1 Yr
2 Yr
3 Yr
4 Yr
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergy or Medical Conditions
Please list/describe any allergies or medical conditions.
Do we have permission to photograph or video your child for promotional use?
Please Select
Yes
NO PHOTO
Child 4
First Name
Last Name
Gender
Female
Male
Date of Birth
-
Month
-
Day
Year
Date
Age/Grade
Please Select
Nursery
1 Yr
2 Yr
3 Yr
4 Yr
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergy or Medical Conditions
Please list/describe any allergies or medical conditions.
Do we have permission to photograph or video your child for promotional use?
Please Select
Yes
NO PHOTO
Child 5
First Name
Last Name
Gender
Female
Male
Date of Birth
-
Month
-
Day
Year
Date
Age/Grade
Please Select
Nursery
1 Yr
2 Yr
3 Yr
4 Yr
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Allergy or Medical Conditions
Please list/describe any allergies or medical conditions.
Do we have permission to photograph or video your child for promotional use?
Please Select
Yes
NO PHOTO
Please List any other kids/students you may be registration (Name, Gender, Date of Birth, Age/Grade).
Would you be willing to be contacted for serving?
Yes
No
If so, which ministry are you interested in serving?
Preschool Ministry (Birth-K5)
Elementary Ministry (1st-3rd)
Preteen Ministry (4th-5th)
Middle School Ministry (6th-8th)
High School Ministry (9th-12th)
KATM Welcome Team
Submit
Should be Empty: