PCK First Time Family Registration Form — Port City Community Church

Please fill out this registration form before you visit Port City Kids for the first time. When you arrive to Port City Church for your first Sunday, come to one of our New Family desks to get checked-in and take a tour. Let us know that you registered ahead of time online so we can save you time and get your family checked-in a little quicker.

Let us know what brings you to Port City!

Select which campus you plan to visit:

Primary Guardian Name

First Name

Last Name

Primary Guardian Relationship to Child/Children

Primary Guardian Email

Primary Guardian Phone

(###)

###

####

Primary Guardian Birthday

YYYY

Family Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Secondary Guardian Name

First Name

Last Name

Secondary Guardian Email

Secondary Guardian Phone

(###)

###

####

Secondary Guardian Birthday

YYYY

Secondary Guardian Address

If different than Family Address, please list the secondary contact address here.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child 1 Information

First Name

Last Name

Child 1 Birthday

YYYY

Child 1 Gender

Child 1 Allergy/Medical Need

Child 2 Information

First Name

Last Name

Child 2 Birthday

YYYY

Child 2 Gender

Child 2 Allergy/Medical Needs

Child 3 Information

First Name

Last Name

Child 3 Birthday

YYYY

Child 3 Gender

Child 3 Allergy/Medical Needs

Child 4 Information

First Name

Last Name

Child 4 Birthday

YYYY

Child 4 Gender

Child 4 Allergy/Medical Needs

Please list any other children in your household's names and birthdays below: