Kids Registration Form

* Indicates required field

Child's Name *

First

Last

Child's Name #2 (Optional) *

First

Last

Age *

Age (Optional) *

T-Shirt Size *

T-Shirt Size (Optional) *

Parent/Guardian Name: *

First

Last

Parent/Guardian Name (Optional): *

First

Last

Email *

Contact Number *

Alternate Emergency Contact *

First

Last

Relationship *

Phone Number *

Authorized to Pick-Up (Other than Parents) *

First

Last

Please inform us of any allergies, medical conditions, or physical or developmental challenges that our staff should be aware of to better understand and accommodate the needs of your child(ren). *

My child(ren) have permission to be photographed during Children’s Ministry activities for Church of God of Prophecy media only: *

Yes No

Local Church *

Children's Ministry Leader's Name *

First

Last

Submit

Your child(s) safety is our first priority. Procedural instructions and other pertinent information will be
sent to you after we received your completed registration form. Thank You!

Kids State Convention Registration