RKC Registration - Reliance Church RVA

Reliance Kids Church Registration Form

Child's First Name_1

Child's Last Name_1

Date of Birth_1

Age_1

Gender_1

Child's First Name_2

Child's Last Name_2

Date of Birth_2

Age_2

Gender_2

Child's First Name_3

Child's Last Name_3

Date of Birth_3

Age_3

Gender_3

Child's First Name_4

Child's Last Name_4

Date of Birth_4

Age_4

Gender_4

Parent's First Name

Parent's Last Name

Enter your mobile phone number to Opt-in for occasional text messages (frequency may vary). Text STOP to 804-630-0002 to Opt-out of future messaging. Text HELP for more information. Message & Data rates may apply.

Allergies/Special Needs of Child(ren)

Photo waiver

We, Reliance Church RVA, have permission to photograph your child(ren).

Photo usage waiver

We, Reliance Church RVA, have permission to use your child(ren)'s photograph in church publications, website, and social media.