Citylight Kids Family Registration

Parent's Name

2nd Parent's Name (if applies)

Optional

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

Optional

2nd Child's DOB

Optional

2nd Child's Allergies

Optional

2nd Child's Gender

Optional

2nd Child's Grade

Optional

3rd Child's Name

Optional

3rd Child's DOB

Optional

3rd Child's Allergies

Optional

3rd Child's Gender

Optional

3rd Child's Grade

Optional

Photo Release

Emergency Contact Name and Number

Description

Sundays @ 9:30am & 11:15am

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

Questions? Email Nick@citylightcb.org.