Riverside Kids Pre-Registration • Riverside Church

Which service do you plan to attend?

Date

Time

9 am

11:30 am

Parent Information

First Name

Last Name

Email Address

Mobile Number

Child's Information

Child's First Name

Child's Last Name

Date of Birth

School Grade

Special Instructions

Special Needs Child

Allergies

Peanuts

Gluten

Eggs

Bees/Wasps

**Please note: When adding additional children, please do not re-enter parent information, you may skip that section for each additional child.**