Let us know about your child

Please help us keep up to date on all our children. Fill out this form and click submit. If you have more than one child, please submit a separate form for each child.

Child Survey Date

*

Parent Name

*

Parent Email

*

This address will receive a confirmation email

Please provide the following information for any child who is under 18 years of age. If you have multiple children, please submit one form per child.

Name

*

Birth date

*

Gender

*

Please select one option.

Male Female

Grade

*

Please select one option.

Not in school K 1 2 3 4 5 6 7 8 9 10 11 12

Has your child been immersed as a believer in Christ?

*

Please select one option.

Yes No

Food Allergies

*

Please select all that apply.

None Eggs Gluten Peanuts Dairy Other

Other Medical or Safety Information

Learning or other disabilities

Please provide emergency contact information. This is the person and number we will try to reach in the event we need to reach out while your child is in our care.

Emergency Contact Name

*

Emergency Contact Phone Number

*

It helps our teachers learn children's names if they have a picture of each child. Kid's change so fast! Can you please attach a recent picture of your child?

Picture

Upload (8MB)

Description

Please help us keep up to date on all our children. Fill out this form and click submit. If you have more than one child, please submit a separate form for each child.

Please Fix the Following

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