Woman’s Life Registration 2014
 
Woman’s Life Registration 2014
Name  * 
Mailing Address  * 
City  * 
State  * 
Zip  * 
Phone
Your Email Address  * 
Birthdate
Anniversary
Church Home
I will be attending the (select one) - if choosing nighttime session, you may leave the rest of the form blank  * 
Because our Kids Life program is run by volunteers we ask that every woman serve twice in the program. Please choose the two dates you are willing to help
How many children K-8th grade will be participating in Kids Life?  * 
First Date
Second Date
Please indicate your choice of Titus Moms/groups. We will place you in a group if left blank.
Please list your children who will be attending with you.
First Child’s Name
Date of Birth
Grade
Gender
Special Needs?
Second Child’s Name
Date of Birth
Grade
Gender
Special Needs?
Third Child’s Name
Date of Birth
Grade
Gender
Special Needs?
Fourth Child’s Name
Date of Birth
Grade
Gender
Special Needs?
Fifth Child’s Name
Date of Birth
Grade
Gender
Special Needs?
Total $
 
 
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