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Moses Lake Bible Church
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Name
(
Required
)
Email Address
(
Required
)
Your Phone Number
Child's Name? (
Required
)
Child's Date of Birth? (
Required
)
Please include the year.
January
February
March
April
May
June
July
August
September
October
November
December
Child's current grade in School? (
Required
)
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Allergies or Medical Info
Emergency Contact (
Required
)
In the event of an emergency, who do we contact? Phone number?
May Moses Lake Bible Church use photos of your child in publications or social media? (
Required
)
Yes
No
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