Parent 1 First Name

Parent 1 Last Name

Parent 2 First Name

Parent 2 Last Name

Parent 1 Email

Parent 2 Email

Parent 1 Phone Number

Parent 2 Phone Number

Family address

Address 2

Country

City

State

Zip/Postal Code

This will be my
First visit to CBC
Second visit to CBC
Third + visit to CBC

Please email me about
Events at CBC
CBC Kids Ministry
CBC Small Groups

Please tell us about the children you'll be registering for CBC Kid's Ministry.

Child #1 Name (please include last name also if different from parent)

Child #1 Birthdate (MM/DD/YYYY)

Child #1 Gender
Male
Female