Immanuel K-Station Registration

2007-2008 Children's Ministry (K-Station) Registration

If you are registering for the first time, please fill in ALL fields.
If you have already registered and need to update your information, please fill in parents names and then ONLY the fields that need to be updated.
If you no longer attend, please fill in your names, check the box below, and click Continue.
After entering information below, click the Continue button at the bottom of the page to continue.

	Mom Info		Dad Info
Mom's First Name:		Dad's First Name:
Mom's Last Name:		Dad's Last Name:
IBC Attender?:		IBC Attender?:
E-mail address:		E-mail address:
Cell phone:		Cell phone:

Address and Home Phone:

Address:
City:
State:
Zip:
Home Phone:

Our family no longer attends Immanuel, please remove our names from the database.

Parents with children in Foggy Bottom (0-23 mo.) and Fort Totten (24 mo. - 3 yrs) are expected to serve every 10-12 weeks. Please indicate your service preference:

Schedule parents on different dates?

Child 1 Info
Name:		Gender:
Date of Birth:	(MM/DD/YYYY)
Age/Grade as of 9/30/07:
Special Instructions /Allergies:

Child 2 Info
Name:		Gender:
Date of Birth:	(MM/DD/YYYY)
Age/Grade as of 9/30/07:
Special Instructions /Allergies:

Child 3 Info
Name:		Gender:
Date of Birth:	(MM/DD/YYYY)
Age/Grade as of 9/30/07:
Special Instructions /Allergies:

Child 4 Info
Name:		Gender:
Date of Birth:	(MM/DD/YYYY)
Age/Grade as of 9/30/07:
Special Instructions /Allergies:


	(click to continue)

If you would like to erase everything and start over, click here: