POP Kids Registration

Student(s)

* First name:	* Last name:	* Gender:	* Grade:
First name:	Last name:	Gender:	Grade:
First name:	Last name:	Gender:	Grade:
First name:	Last name:	Gender:	Grade:
First name:	Last name:	Gender:	Grade:

Mom

First name:		Last name:
Work Phone:		Cell Phone:		include area codes

Dad

First name:		Last name:
Work Phone:		Cell Phone:		include area codes

Family Situation

* Select one:

If other:

Primary Contact

* Address of:	If other:
* Address:
* City:	* State:		* Zip Code:
* Email:	* Phone:	include area code

* How do you prefer to receive news from POP Kids?
Email address for POP Kids information and updates:

Secondary Contact (if needed)

Address of:	If other:
Address:
City:	State:		Zip Code:
Email:	Phone:	include area code

How do you prefer to receive news from POP Kids?
Email address for POP Kids information and updates:

Worship

* What worship service does your family typically attend?:
Saturdays at 5:00pm at Prince of Peace
Sundays at 8:00am at Prince of Peace
Sundays at 9:30am at Prince of Peace
Sundays at 11:00am at Prince of Peace
We worship at our home congregation
None, we don't attend worship

Family Information