Junior Jivers Registration Form
Please complete for each person who would be attending (including the adult).
First Name
*
Gender
*
Male
Female
Email Address
*
Allergies
*
No known allergies
Yes (has allergies)
Can we take photos and/or video of your child? We love showing people what happens at our church so these images can be used in our communications (including online) in promotion of our church and its' activities. *
*
Yes
No
Last Name
*
Date of Birth
*
Mobile Number
*
Allergy Description
Remove
Add Another Person
Submit