Welcomes to the KAPOW Registration Form!
Let's Get Started!
 
Child's First and Last Name *

 
Child's Birthdate *

mm/dd/yyyy
 
Grade Child is Entering/Entered for 2016/17 School Year *


 
Name of Parents/Guardians *

First and Last Name, Please
 
Child Lives With *


 
Address *

Street 1
Street 2
City, State Zip
 
Phone Number *

 
Secondary Phone Number *

 
Food Allergy/Medical Conditions *

We care about your child! Let us know of any allergies, illnesses, or other items we need to know to take care of your child. If this does not apply to your child, enter 'N/A'.
 
Emergency Contact *

Please provide the name and phone number of somebody to contact in the event you cannot be reached. Please also include the relation to the child.
 
In the event of an emergency, I authorize Yorkshire United Methodist Church to provide any first aid care or secure any transportation and emergency care deemed necessary. *

     
 
Additional Information we need to know?

 
Thank You For Submitting Your Registration for KAPOW!

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