Biennial Conference Kidz Ministry

Parent/Guardian Registration Info

First Name *

Last Name *

Relationship to child *

Cell (in case of emergency) *

Email *

Street Address *

City, Province/State, Postal/Zip, Country *

Event Fee(s)

Please enter how many children will be attending Kids Ministry.

Per child

CA$50.00

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Kidz Ministry First Child's Information

First Name *

Last Name *

Gender *

Date of Birth *

Special Needs/Allergies/Other Medical Information *

If none for Special Needs, please put "None"

Kidz Ministry Second Child's Information

First Name

Last Name

Gender

Date of Birth

Special Needs/Allergies/Other Medical Information

If none for Special Needs, please put "None"

Kidz Ministry Third Child's Information

First Name

Last Name

Gender

Date of Birth

Special Needs/Allergies/Other Medical Information

If none for Special Needs, please put "None"

Kidz Ministry Fourth Child's Information

First Name

Last Name

Gender

Date of Birth

Special Needs/Allergies/Other Medical Information

If none for Special Needs, please put "None"

Kidz Ministry Fifth Child's Information

First Name

Last Name

Gender

Date of Birth

Special Needs/Allergies/Other Medical Information

If none for Special Needs, please put "None"