Lake Cooley Kids at The Mill Midweek Registration
This form has moved. Please
CLICK HERE
to be redirected.
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:
*
Format: (000) 000-0000.
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
Should be Empty: