Chisholm Heights Baptist Church

PDO Fall 2024 Registration

To register, please take the time to fill out the information below.

Full Name of Child

Birthdate

Age

Gender

Allergies, Limitations, Medical Conditions

Parent/Gaurdian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Church Affiliation

Emergency Contacts - Name, Phone Number, and Relation to Child