New Family Registration - CBC Kids

We are so excited to have to visit us at Crossroads Bible Church!
Please complete the information below and we can't wait to meet your child!

Parent 1 First Name

Parent 1 Last Name

Parent 2 First Name

Parent 2 Last Name

Parent 1 Email

Parent 2 Email

Parent 1 Phone Number

Parent 2 Phone Number

Family address

Address 2

Country

City

State

Zip/Postal Code

This will be my
First visit to CBC
Second visit to CBC
Third + visit to CBC

Please email me about
Events at CBC
CBC Kids Ministry
CBC Small Groups

Please tell us about the children you'll be registering for CBC Kid's Ministry.

Child #1 Name (please include last name also if different from parent)

Child #1 Birthdate (MM/DD/YYYY)

Child #1 Gender
Male
Female

If this child is in school, what grade will they be in for the 2022-2023 school year?

Please share any allergies or medical conditions we need to know about this child:

Child #2 Name (please include last name also if different from parent)

Child #2 Birthdate (MM/DD/YYYY)

Child #2 Gender
Male
Female

If this child is in school, what grade will they be in for the 2022-2023 school year?

Please share any allergies or medical conditions we need to know about this child:

Child #3 Name (please include last name also if different from parent)

Child #3 Birthdate (MM/DD/YYYY)

Child #3 Gender
Male
Female

If this child is in school, what grade will they be in for the 2022-2023 school year?

Please share any allergies or medical conditions we need to know about this child:

Child #4 Name (please include last name also if different from parent)

Child #4 Birthdate (MM/DD/YYYY)

Child #4 Gender
Male
Female

If this child is in school, what grade will they be in for the 2022-2023 school year?

Please share any allergies or medical conditions we need to know about this child:

Child #5 Name (please include last name also if different from parent)

Child #5 Birthdate (MM/DD/YYYY)

Child #5 Gender
Male
Female

If this child is in school, what grade will they be in for the 2022-2023 school year?

Please share any allergies or medical conditions we need to know about this child:

Child #6 Name (please include last name also if different from parent)

Child #6 Birthdate (MM/DD/YYYY)

Child #6 Gender
Male
Female

If this child is in school, what grade will they be in for the 2022-2023 school year?

Please share any allergies or medical conditions we need to know about this child: