Kids Club Registration *Denotes Required Field * Title * Email * Phone () – * Address 1 Address 2 * City State/Prov * Zip/Postal Code * Child's Full Name * Mother's Full Name * Father's Full Name Guardian * Date of Birth Home Church * Grade School * Care Card * Physician * Allergies/Health Concerns/Medications * Please provide a 4-digit security code to be used when your child is picked up: * Who is authorized to pick your child(ren) up from Kids Club? Name and Relationship to Child.
