Registration Form

By clicking the 'SUBMIT' button you are giving the child listed permission to attend a Crestmont K.I.D.S. event at Crestmont Baptist Church. You give permission for the child to participate in activities/games inless otherwise listed in the restrictions area. You agree not to hold Crestmont Baptist church, Crestmont staff or the event workers liable in the event of an accident. You do, however, give permission to seek medical attention if necessary. Please submit one registration per child.

Event Name:
*
Child's Name:
*
Guardian's Name:
*
Email Address:
Address:
*
City:
*
State:
*
Zip Code:
*
Phone Number:
Child's Grade Fall 06':
*
T-Shirt Size:
*
Emergency Phone Numbers:
*
Medical Restrictions:
Any Allergies:
Security code:
*
Do not enter anything in this field:

* indicates a required field