Title *

First Name *

Last Name *

Relationship to Child *

Specify Relationship With Child (If "Other" Was Selected) *

Tip: Leave blank if already specified

Mobile Number *

Email Address *

Title

First Name

Last Name

Relationship To Child

Specify Relationship With Child (If "Other" Was Selected)

Tip: Leave blank if already specified

Mobile Number

Email Address

What's Your Connection To Lightpoint Church? *

Do You Have Ambulance Cover? *

Address Line 1 *

Address Line 2

Suburb *

State *

Postal Code *

First Name *

Last Name *

Age *

Gender *

Date Of Birth *

Select the room your child will be in according to age: *

Allergies *

Tip: Please list any allergies (Food, Insect, Medication or other)

Conditions/Special Needs *

Tip: Any other medical conditions i.e. Asthma, etc?

Emergency Contact 1 *

Emergency Contact 2 *

First Name

Last Name

Age

Gender

Date Of Birth

Select the room your child will be in according to age:

Allergies

Tip: Please list any allergies (Food, Insect, Medication or other)

Conditions/Special Needs

Tip: Any other medical conditions i.e. Asthma, etc?

Emergency Contact 1

Emergency Contact 2

First Name

Last Name

Age

Gender

Date Of Birth

Select the room your child will be in according to age:

Allergies

Tip: Please list any allergies (Food, Insect, Medication or other)

Conditions/Special Needs

Tip: Any other medical conditions i.e. Asthma, etc?

Emergency Contact 1

Emergency Contact 2

First Name

Last Name

Age

Gender

Date Of Birth

Select the room your child will be in according to age:

Allergies

Tip: Please list any allergies (Food, Insect, Medication or other)

Conditions/Special Needs

Tip: Any other medical conditions i.e. Asthma, etc?

Emergency Contact 1

Emergency Contact 2

I Give Permission For My Child To Be Photographed/Filmed For Lightpoint Promotions *

I Give Permission To Receive Further Information About Kids Church via Email and/or Text Message *