Connections Registration

Kids Konnection Registration Form

Please fill out the form below to ensure your child is registered for Kid's Konnection. This form will only register your child. You will register for the bible study at the Connections Kick-Off.

* Required

Mother's First Name:*

Mother's Last Name:*

Mother's Home Phone:*

Mother's Cell Phone:*

Mother's Email Address:*

1st Child's Name:

1st Child's Birthdate - MM/DD/Year:

If Child #1 is under 2 years old, please let us know where he/she is developmentally:
Not crawling
Crawling
Walking

2nd Child's Name:

2nd Child's Birthdate - MM/DD/Year:

If Child #2 is under 2 years old, please let us know where he/she is developmentally:
Not crawling
Crawling
Walking

3rd Child's Name:

3rd Child's Birthdate - MM/DD/Year:

4th Child's Name:

4th Child's Birthdate - MM/DD/Year:

5th Child's Name:

5th Child's Birthdate - MM/DD/Year:

Please let us know if there are any food allergies or other health issues that we need to be aware of for your child(ren)? :

Submit Registration

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