Kaleidoscope Worship Education: Summer 2019 Registration

Family Information

1st Parent's Name

*

Cell Phone

*

2nd Parent's First Name

2nd Parent's Last Name

Cell Phone

Children Information

1st Child's Name

*

1st Child's Age or Grade Level

*

2nd Child's Name

2nd Child's Age or Grade Level

Additional Information

Individuals authorized to pick up children. These individuals must have a clothespin with the Kaleidoscope child's name on it.

Name

Relationship to Child

Name

Relationship to Child

Name

Relationship to Child

Name

Relationship to Child

Please list any special needs such as food allergies, bee allergies, and learning needs that your child has.

Does your family have court appointed custody agreement information for the child in Kaleidoscope?

*

Yes No

If yes, please provide additional information.

Parent Signature (Please type your digital signature.)

*

Date

*

Description

Please fill out this form and click submit to register your 3-year-old through first grade (Fall 2019) child for Kaleidoscope Worship Education at Covenant Presbyterian Church.