School Supply Registration

Each Child MUST Be Registered Seperately

• Full Name*

  Name of Parent or Guardian

  Prefix

  First Name

  Middle Name

  Last Name
• Address*

  Address Line 1
  Address Line 2
  City	State
  Zip Code	Country
• Email Address*

  eg. xyz@domain.com
• Please Select One*

  I regularly attend church

  I do not regularly attend church
• Please Select One*

  I believe there is a God.

  I do not believe there is a God
• Please Select One*

  I am interested in learning more about God.

  I am not interested in learning more about God.
• In your opinion what one thing keeps people out of church?*

  A previous bad experience

  It is boring

  The church is full of hypocrites

  The teaching isn't relevant

  Other
• Name of Child*

  Prefix

  First Name

  Middle Name

  Last Name
• Child's Grade*

  Kindergarten	First	Second
  Third	Fourth	Fifth
  Sixth
•  

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