Radiant Kids Pre-Registration
Please fill out this form and click submit.
Parent Information
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Do you give permission for your child to be included in photos shared on the church’s social media (e.g., Facebook, Instagram)?
*
Please select all that apply.
Yes, I give permission.
No, do not take or share any pictures including my child.
Child Information
Child's Name
*
Date of Birth
*
Class
*
Please select one option.
Birth-2 years old
PreK-K
1st-4th grade
Select Option
Birth-2 years old
PreK-K
1st-4th grade
Known allergies, medical conditions or other helpful information.
*
Potty Training/Diaper Changing Preferences
*
Please select all that apply.
My child is potty trained.
My child needs assistance going to the bathroom.
I prefer Radiant Kids workers to change diapers.
I prefer to be contacted if my child needs a diaper change.
Child's Name
Date of Birth
*
Class
Please select one option.
Birth-2 years old
PreK-K
1st-4th grade
Known allergies, medical conditions or other helpful information.
Potty Training/Diaper Changing Preferences
Please select all that apply.
My child is potty trained.
My child needs assistance going to the bathroom.
I prefer Radiant Kids workers to change diapers.
I prefer to be contacted if my child needs a diaper change.
Child's Name
Date of Birth
*
Class
Please select one option.
Birth-2 years old
PreK-K
1st-4th grade
Known allergies, medical conditions or other helpful information.
Potty Training/Diaper Changing Preferences
Please select all that apply.
My child is potty trained.
My child needs assistance going to the bathroom.
I prefer Radiant Kids workers to change diapers.
I prefer to be contacted if my child needs a diaper change.
Child's Name
Date of Birth
*
Class
Please select all that apply.
Birth-2 years old
PreK-K
1st-4th grade
Known allergies, medical conditions or other helpful information.
Potty Training/Diaper Changing Preferences
Please select all that apply.
My child is potty trained.
My child needs assistance going to the bathroom.
I prefer Radiant Kids workers to change diapers.
I prefer to be contacted if my child needs a diaper change.
Child's Name
Date of Birth
*
Class
Please select one option.
Birth-2 years old
PreK-K
1st-4th grade
Known allergies, medical conditions or other helpful information.
Potty Training/Diaper Changing Preferences
Please select all that apply.
My child is potty trained.
My child needs assistance going to the bathroom.
I prefer Radiant Kids workers to change diapers.
I prefer to be contacted if my child needs a diaper change.
Submit
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