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Kiddie Kampus Registration Application

Please fill out the information completely. Fields marked with a * are required.

For which session are you applying? *

Child's Name *

First

Last

Birthdate (MM/DD/YYYY) *

Place of Birth *

Gender *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email Address *

Mother/Guardian Name *

First

Last

Mother/Guardian Occupation *

Mother/Guardian Phone *

Mother/Guardian Work Phone *

Mother/Guardian Address (If different than child's) *

Line 1

Line 2

City

State

Zip Code

Country

Father/Guardian Name *

First

Last

Father/Guardian Phone *

Father/Guardian Occupation *

Father/Guardian Work Phone *

Father/Guardian Address (If different than child's) *

Line 1

Line 2

City

State

Zip Code

Country

Is child adopted? *

If adopted, at what age was adoption? *

If adopted, is child aware of adoption? *

Please describe any custody arrangements, if applicable, regarding the child’s visitation with a parent/guardian *

Submit

Click here to make online application fee payment after clicking "Submit" on above form ($30 before June 1; $60 if after June 1)

Kiddie Kampus Registration Application

Upland United Methodist Church