787 Kids Registration
Please fill out this form and click submit.
Child's Name
*
Child's Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Phone
*
Child's Birthday
*
Child's Gender
*
Please select all that apply.
male
female
Mother's Name
*
Child's Grade
*
Please select one option.
PreK
kindergarten
1st
2nd
3rd
4th
5th
6th
Mother's Phone
*
Father's Name
*
Father's Phone
*
Emergency Contact's Name
*
Emergency Contact's Phone
*
Special Instructions for Child ( Allergies, restrictions, etc...)
*
Does your family have a church home?
*
By submitting this form, you, the parent/guardian of the above listed child, are giving permission for him/her to participate in 787 Kids at Central Baptist church, Corning, NY. Also giving your permission for Central Baptist Church to consent to medical treatment if necessary. As well as giving your permission for your child's photo to be used on the churches website and/or the churches social media pages, and all promotional materials. You will be asked to sign this form upon arrival.
*
Submit
Description
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