Kids Ministry Connection Form

We are so glad that you are here at Poplar Springs Christian Church. Please fill out the form below with your families information.
By filling out this form, you will be automatically added to our Kids Ministry Weekly Email, so you can be up to date on what's going on in our ministry.

Parent Contact Information

Parent Name:

*

Parent Phone:

*

Email Address:

*

This address will receive a confirmation email

Parent Name:

Parent Phone:

Email Address:

Family Address

*

Do you have a home church?

*

How did you hear about us?

*

Child #1 Information

Child Name:

*

Gender:

*

Please select one option.

Male Female

Birth Date:

*

Grade:

*

Please select one option.

N/A PreK Kindergarten 1st 2nd 3rd 4th 5th

Allergies or Medical Needs:

*

Child #2 Information

Child Name:

Gender:

Please select one option.

Male Female

Birth Date:

Grade:

Please select one option.

N/A PreK Kindergarten 1st 2nd 3rd 4th 5th

Allergies or Medical Needs:

Child #3 Information

Child Name:

Gender:

Please select one option.

Male Female

Birth Date:

Grade

Please select one option.

N/A PreK Kindergarten 1st 2nd 3rd 4th 5th

Allergies or Medical Needs:

Child #4 Information

Child Name:

Gender:

Please select one option.

Male Female

Birth Date:

Grade:

Please select one option.

N/A PreK Kindergarten 1st 2nd 3rd 4th 5th

Allergies or Medical Needs:

Child #5 Information

Child Name:

Gender:

Please select one option.

Male Female

Birth Date:

Grade:

Please select one option.

N/A PreK Kindergarten 1st 2nd 3rd 4th 5th

Allergies or Medical Needs:

Description

We are so glad that you are here at Poplar Springs Christian Church. Please fill out the form below with your families information.
By filling out this form, you will be automatically added to our Kids Ministry Weekly Email, so you can be up to date on what's going on in our ministry.

Please Fix the Following

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