Child Evangelism Ministries

York Registration Form

• Child's Name*
  First Name

  Last Name
• Grade*
  >Kindergarten First GradeSecond GradeThird GradeFourth GradeFifth GradeSixth Grade
• Child's Name
  Additional Children
  First Name

  Last Name
• Grade
  Grade your child is in.
  >Select GradeKindergarten First GradeSecond GradeThird GradeFourth GradeFifth GradeSixth Grade
• Child's Name
  Additional Children
  First Name

  Last Name
• Grade
  Grade your child is in.
  >Select GradeKindergarten First GradeSecond GradeThird GradeFourth GradeFifth GradeSixth Grade
• Parent or Guardian*
  First Name

  Last Name
• Phone Number*
  A phone number is required for our team to reach you in case of an emergency and for your child's safety.
   

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• Parent or Guardian
  First Name

  Last Name
• Phone Number
   

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• Address*
  Street Address*

  Address Line 2

  City*

  Province / State / Region*

  Postal Code / Zip

  Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

  Country*
• Your E-mail*
   
• Emergency Contact Person #1*
  We must have two additional contacts in case we are unable to reach you in case of an emergency.
  First Name

  Last Name
• Emergency Contact Phone Number*
   

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• Emergency Contact Person #2*
  First Name

  Last Name
• Emergency Contact Phone Number*
   

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