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New Family Registration Form

We love having new families! If you're visiting Chesapeake Church for the first time, please enter your information below. On your next visit, be sure to come a 10 minutes early to give us the opportunity to welcome you! We will also record your photograph and fingerprints.

Thank you!

Household Last Name*
Address *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Home Phone
Mother's Name
First Name
Middle
Last Name
Mother's Cell Phone
Your Email*
Mother's Birthdate
May we call or text in the case of an emergency?*
Father's Name
First Name
Middle
Last Name
Father's Cell Phone
May we call or text you in the case of an emergency?
Father's Birthdate
Children's Names
Children's Gender *
Children's Birthdays - Please fill out the child's complete birthday (DD/MM/YYYY) *
Ages (Please include first names with the ages.)
Please enter the grade(s) that your child/children is currently in
Any medical conditions (asthma, food allergies, special needs or medical needs, etc)
Any behavior notations (separation anxiety, extreme shyness, etc)
Your phone number that we can reach you TODAY if we have questions inputting your registration data.*
Which service do you plan on attending this weekend? *
Is this your first visit with us? *
To combat spam, type PEAKE in the box: *

Parents with children participating in weekend services, LifeStudy classes or any sponsored Chesapeake Church event, automatically give Chesapeake Church permission to use photo or video footage for website or social media purposes. Parents who wish their children do not have their picture taken or be involved in video footage, please contact the Children’s Pastor.