NC Kids Convention Registration

2019 NC Kids Convention Registration

* Indicates required field

Name *

First

Last

Age *

Church Home *

Children’s Minister/Pastor *

Parent(s)/Guardian(s) Name(s): *

First

Last

Email *

Contact Number during State Convention *

Alternate Emergency Contact *

First

Last

Relationship *

Phone Number *

Authorized to Pick Up (Other than Parents) *

First

Last

Please list any allergies, medical conditions, physical or developmental challenges our staff should be aware of to better understand and meet the needs of your child. *

My child has permission to be photographed during Children’s Ministry activities for Church of God of Prophecy media only. *

Yes No

Additional Comments *

Submit