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PLAN YOUR VISIT
CW KIDZ REGISTRATION
Guide
2020-06-06T18:58:13+00:00
CW Kids Registration
GOD HAS A BEAUTIFUL PLAN FOR YOUR KIDS, LET’S HELP THEM DISCOVER IT!
Step
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4
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Child's Information
First name
Last name
Birth date (mm/dd/yy)
Gender
Male
Female
Current grade
School
Address
City
State
Zipcode
Family Information
First name of father / guardian
Last name of father / guardian
Relationship
Father
Guardian
First name of mother / guardian
Last name of mother / guardian
Relationship
Mother
Guardian
Home phone
Cell phone
Email address
Are both parents living at home?
Yes
No
Who has legal custody of the child?
If the person who regularly brings the child to church is different then above, please list:
Medical Information And Other Concerns And/Or Behaviors
My child has medical concerns of which the church should be aware.
Yes
No
My child has: (i.e. allergies, asthma, epilepsy, seizures) Please list:
My child’s allergies can be life threatening
Yes
No
My child’s allergies may require the use of an EpiPen
Yes
No
Are there any concerns or behaviors you would like to share with us?
Yes
No
What concerns or behaviors should we be aware of?
Special Needs Information
My child has an Individualized Education Program (IEP).
Yes
No
Please indicate the child’s area of eligibility for an IEP.
Autism
Emotional Disturbance
Intellectual Disability
Traumatic Brain Injury
Specific Learning Disability
Language Impairment
Speech Impairment
Visual Impairment
Multiple Disabilities
Orthopedic Impairment
Developmental Delay
Other Health Impairment
Deaf
Blind
I am willing to speak with a children's team leader so that my child's special needs are met while I attend service.
Yes
No
Phone
This field is for validation purposes and should be left unchanged.
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