Register

Child's First Name:
Child's Last Name:
Date of Birth:
Grade Completed:
Age:
Parent's First Name:
Parent's Last Name:
Address:
City:
State:
zip:
Home Phone:
Cell Phone:
E-mail:
Emergency First Name:
Emergency Last Name:
Emergency Phone:
Special Needs / Allergies:
Person Responsible for Pickup after VBS:
Their phone number:
Relationship to child:
What church do you normally attend?
It is understood that every precaution will be taken for the safety and well-being of my child, but in the event of accident or sickness, Kenmore Alliance Church, its staff and its volunteers are hereby released from any liability. Do you agree to this?
Would you like more information about our church or children's ministry?
Would you like to be contacted by one of our staff members?
Would you like to volunteer to help in our church or children's ministry?