KIDTRICITY

An "electric" summer kids program beginning May 8th, 2019 and continuing through August, 7th 2019.  Ages 3-6th grade are welcome to be a part of this ministry.  Email mdecker@faithpb.com with questions.  

Register here...

KIDTRICITY Summer 2019 Registration Form

We're excited to have your child join us! Please complete this form and press "Send" when you're done.

Family Information

Parent/Guardian Name(s)

First & Last Name(s)

Primary Phone #

Secondary Phone #

Primary Email Address

Street Address

Address (continued)

City

State

Please select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Island Northern Mariana Islands Guam American Samoa Palau

Zip

Home Church

Child/Children Information

First Name

Last Name

Date of Birth

Grade (Entering in Fall 2019)

Please select... 3 year old (age currently) 4 year old (age currently) 5 year old (age currently) K5 1st 2nd 3rd 4th 5th 6th

Gender

Please select... Male Female

Allergies/Other Info

T-Shirt Order (Optional)

KIDTRICITY T-shirts are $6 each and are optional.  You may order multiples if desired.  Payment due when shirt received.

*Actual shirt may vary slightly from picture*

T-Shirt Color

Please select... Safety Orange Safety Green Safety Pink

T-Shirt Size

Please select... Youth XS Youth S Youth M Youth L Youth XL Adult S Adult M Adult L Adult XL Adult 2XL Adult 3XL Adult 4XL Adult 5XL

Contact Information