Kid Nation Children's Ministry
Registration
Child's First Name:
Child's Last Name:
Child's Date of Birth:
Gender:
Select Gender
Male
Female
Homeschool:
Homeschool?
Yes
No
School Name:
Child's Grade:
Select Grade
Nursery I (0-18 months)
Nursery II (18 months - 2 years old)
PreSchool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
Guardian #1 Full Name:
Relationship to Child:
Guardian #1 Phone Number:
Guardian #2 Full Name:
Relationship to Child:
Guardian #2 Phone Number:
Home Address:
City:
Zip Code:
Family Email Address:
Known Allergies:
Health Concerns:
Educational Concerns:
Person(s) Child May Be Released To:
Additional Information:
I have read and agree to the
General Liability Waiver
of Save the Nations, Kid Nations Ministry.