Kids & Family Registration Form


Thank you for having your children participate in our ministry! Please provide the necessary information below, even if you have registered in the past. Your submission will be sent to Essex Alliance Church.

You need to enter in the information with a red star next to it, and you must click on the blue Continue button at the very bottom of this page for your information to be submitted.

Note: We use your child's age and grade as of September 1st, 2012 to determine what ministry your child will be in for the entire school year.

f you have more than 4 children to register, please submit a second online registration form.

Parent (s) or Guardians names (First & Last)
First time to register at Fusion?
  • Yes - 1st Time
  • No - registered before
Address
City
State (use VT for Vermont)
Zip Code
Phone number
Household email address (or type NONE)
Name of Emergency Contact
Emergency Phone Number
Do any of your children have allergies or other special needs? (If you answer yes, you will be given a box to give us the details after you hit Continue at the bottom of this page)
  • No
  • Yes - Allergies or other needs
Are you or your spouse involved in MOPS (Mothers of Preschoolers) at EAC?

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Information for your First Child

First Child's Name (First & Last)
First Child's Gender
First Child's Grade
First Child's Birth Month
First Child's Birth Day
First Child's Birth Year

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Information for Second Child (leave blank in not needed)

Second Child's Name (First & Last)
Second Child's Gender
Second Child's Grade
Second Child's Birth Month
Second Child's Birth Day
Second Child's Birth Year

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Information for Third Child (leave blank in not needed)

Third Child's Name (First & Last)
Third Child's Gender
Third Child's Grade
Third Child's Birth Month
Third Child's Birth Day
Third Child's Birth Year

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Information for Fourth Child (leave blank in not needed)

Fourth Child's Name (First & Last)
Fourth Child's Gender
Fourth Child's Grade
Fourth Child's Birth Month
Fourth Child's Birth Day
Fourth Child's Birth Year