Woman’s Life Registration
 
Woman’s Life Registration
Name  * 
Mailing Address  * 
City  * 
State  * 
Zip  * 
Phone
Your Email Address  * 
Birthdate
Anniversary
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
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. Indicate a choice of class for each child (2nd-8th) during each time slot.
Children up to 17 years old can participate in Presidential. There is a separate form that must be filled out for each family that participates.
First Child's Name
Date of Birth
Grade
Gender
Special Needs?
9:45 - 11:00
11:00 - 12:15
Second Child's Name
Date of Birth
Grade
Gender
Special Needs?
9:45 - 11:00
11:00 - 12:15
Third Child's Name
Date of Birth
Grade
Gender
Special Needs?
9:45 - 11:00
11:00 - 12:15
Fourth Child's Name
Date of Birth
Grade
Gender
Special Needs?
9:45 - 11:00
11:00 - 12:15
Fifth Child's Name
Date of Birth
Grade
Gender
Special Needs?
9:45 - 11:00
11:00 - 12:15
 
 
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