Lake Cooley Kids at The Mill Midweek Registration

Lake Cooley Kids at The Mill Midweek Registration
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Parent's Name

First NameLast Name
Parent's Name 2

First NameLast Name
Please list both parents if applicable.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Cell:
Format: (000) 000-0000.
Parent's Email:
example@example.com
Please list your Kid(s) Name, Age AND Grade.
Child 1

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Age/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?
If the answer is yes for all children, mark yes. here. Otherwise specify which child cannot be photographed below.
Child 2

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Age/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?
Child 3

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Age/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?
Child 4

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Age/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?
Child 5

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Age/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 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?
If so, which ministry are you interested in serving?
Should be Empty:

Lake Cooley Kids at The Mill Midweek Registration

This form has moved. Please CLICK HERE to be redirected.