NEXTGEN & FAMILY

REGISTRATION FORM


This form is for NEW registrations.

If you've already registered with us, we've gotchya! We'll see ya soon! 

If you'd like to INFORM US OF CHANGES (change of address, phone number, email, etc.), CLICK HERE.

IF YOU'RE NEW and are ready to register your family for Covenant Kids, Student Life, or Family Village, complete this form. 

Try to complete it in one sitting though. It won't save if you don't.

 

Guardian Information

Guardian 1 Full Name: *
First Name
Middle
Last Name
Guardian 1 Relationship to Child/Student:*
Guardian 1 Cell Phone:
Guardian 1 May We Text You?
Guardian 2 Full Name: *
First Name
Middle
Last Name
Guardian 2 Relationship to Child/Student:
Guardian 2 Cell Phone:
Guardian 2 May We Text You?
Do guardians reside at the same address?
Primary Phone:*
Address where child/student resides: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Email 1:*
Email 2:
Name the Authorized Adults (must be 16 years or older) allowed to pick up child. Please name only those most likely to be asked to pick child up on regular basis. Include mobile phone and any other needed information. *
Name of Emergency Contact 1 (besides guardian(s) we can contact in case of emergency). *
Emergency Contact 1 Phone:*
Name of Emergency Contact 2 (besides guardian(s) we can contact in case of emergency).
Emergency Contact 2 Phone:

Release

I, We, the guardian(s) of child(ren) below, do release the Covenant Church and any staff or volunteers associated with the Covenant Church of any and all legal responsibility for accidental injuries. In case of emergency, we hereby give permission to a physician or hospital to provide treatment for our child(ren) as deemed necessary by the appropriate medical professionals and my child's medical history, should the guardian be unreachable.*
Guardian Signature. Enter your full name here.*

Child 1

Child 1 Full Name: *
First Name
Middle
Last Name
Child 1 Gender:*
Child 1 Date of Birth:*
Child 1 Age:*
Child 1 Grade:*
Child 1 School:*
Child 1 Mobile Phone:
Child 1 Allergies:
Child 1 Dietary Concerns:
Child 1 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 1.

Media Release

Continue to Add Another Child

Click Here to Skip Ahead



Child 2

Child 2 Full Name
First Name
Middle
Last Name
Child 2 Gender
Child 2 Date of Birth:
Child 2 Age:
Child 2 Grade:
Child 2 School:
Child 2 Mobile Phone:
Child 2 Allergies:
Child 2 Dietary Concerns:
Child 2 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 2.

Media Release

Continue to Add Another Child

Click Here to Skip Ahead



Child 3

Child 3 Full Name:
First Name
Middle
Last Name
Child 3 Gender:
Child 3 Date of Birth:
Child 3 Age:
Child 3 Grade:
Child 3 School:
Child 3 Mobile Phone:
Child 3 Allergies:
Child 3 Dietary Concerns:
Child 3 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 3.

Media Release

Continue to Add Another Child

Click Here to Skip Ahead



Child 4

Child 4 Full Name:
First Name
Middle
Last Name
Child 4 Gender:
Child 4 Date of Birth:
Child 4 Age:
Child 4 Grade:
Child 4 School:
Child 4 Mobile Phone:
Child 4 Allergies:
Child 4 Dietary Concerns:
Child 4 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 4.

Media Release

Continue to Add Another Child

Click Here to Skip Ahead



Child 5

Child 5 Full Name:
First Name
Middle
Last Name
Child 5 Gender:
Child 5 Date of Birth:
Child 5 Age:
Child 5 Grade:
Child 5 School:
Child 5 Mobile Phone:
Child 5 Allergies:
Child 5 Dietary Concerns:
Child 5 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 5.

Media Release

Continue to Add Another Child

Click Here to Skip Ahead



Child 6

Child 6 Full Name:
First Name
Middle
Last Name
Child 6 Gender:
Child 6 Date of Birth:
Child 6 Age:
Child 6 Grade:
Child 6 School:
Child 6 Mobile Phone:
Child 6 Allergies:
Child 6 Dietary Concerns:
Child 6 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 6.

Media Release

 

Continue to Add Another Child

Click Here to Skip Ahead



Child 7

Child 7 Full Name:
First Name
Middle
Last Name
Child 7 Gender:
Child 7 Date of Birth:
Child 7 Age:
Child 7 Grade:
Child 7 School:
Child 7 Mobile Phone:
Child 7 Allergies:
Child 7 Dietary Concerns:
Child 7 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 7.

Media Release

Continue to Add Another Child

Click Here to Skip Ahead



Child 8

Child 8 Full Name:
First Name
Middle
Last Name
Child 8 Gender:
Child 8 Date of Birth:
Child 8 Age:
Child 8 Grade:
Child 8 School:
Child 8 Mobile Phone:
Child 8 Allergies:
Child 8 Dietary Concerns:
Child 8 Notes:

Program Enrollment

Please select the program(s) for which you are registering Child 8.

Media Release

 

You're all done!

Click the button below to submit your registration