Citylight Kids Family Registration

Parent's Name

2nd Parent's Name (if applies)

This address will receive a confirmation email

Phone

Address

Child's Name

Child's DOB

Child's Allergies

Gender

Male Female

Grade

2nd Child's Name

2nd Child's DOB

2nd Child's Allergies

2nd Child's Gender

2nd Child's Grade

3rd Child's Name

3rd Child's DOB

3rd Child's Allergies

3rd Child's Gender

3rd Child's Grade

Photo Release

Emergency Contact Name and Number

Description

Sundays @ 9:00am & 11:00am

Please fill out this form for your children attending Citylight Kids classes. Thanks!

Questions? Email doug@citylightcb.org.