CrossRoads Kids Child Information Form

Please fill out one form for each child in the household

Your name *

Last name

Email address *

Phone number *

Phone type

MobileHomeWorkOther

Address

HomeWorkOther

Country

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Gender

Select…MaleFemale

Birthday *

Grade

Select…Pre-KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade

School

Select…Olds Koinonia Christian SchoolGatewayHome SchoolRed Deer Koinonia Christian SchoolOlds Koinonia Christian SchoolGatewayCentralCentralHome SchoolSt ThomasEastviewSt FrancisIRJCWestparkPoplar RidgeMother TeresaSt. PatricksCamille LerougePenhold CrossingSt. MargeruiteLeslievilleSt GregoryBentleyNotre DameEcole LacombeCrestomereRed Deer Koinonia Christian SchoolOlds Koinonia Christian SchoolGatewayHome SchoolEastviewIRJCWestparkPoplar RidgeMother TeresaSt. PatricksCamille LerougePenhold CrossingSt. MargeruiteLindsay ThurberHunting HillsLacombe CompLeslievilleLacombe ChristianSt GregoryBentleyNotre DameOldsEcole LacombeCentral Alberta Christian Red Deer Koinonia Christian School

Medical note

I do not give CrossRoads Church permission to use photos or videos of my child(ren) for social media or advertising purposes.

Submit

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