Children's Ministries Registration

Infant - 5th Grade

Parent/Guardian Information

1st Parent/Guardian

Name: *

Relationship to Child: *

Cell Phone: *

Home Phone: *

Work Phone:

2nd Parent/Guardian

Name:

Relationship to Child:

Cell Phone:

Home Phone:

Work Phone:

Home Information

Address: *

City: *

State: *

Zip: *

Additional Mailing Address:

Which email address would you like to receive updates on your child's classroom:

Informational Questions

Service your child(ren) will attend most regularly:

9:00 AM

10:45 AM

Both

We use digital photos in our ministry and often publish them without names on our website or printed publications. Do you give permission for your child(ren)'s photos to be included in our communication?: *

Yes

Emergency Contact Information

Which parent/guardian contact information should we use in case of emergency: *

Parent/Guardian 1

Parent/Guardian 2

Child Information

Child 1

Child's Name (First and Last):

Date of Birth:

Grade:

Child 2

Child's Name (First and Last):

Date of Birth:

Grade:

Child 3

Child's Name (First and Last):

Date of Birth:

Grade:

Child 4

Child's Name (First and Last):

Date of Birth:

Grade:

Do any of the listed children have allergies/medical concerns? If so, please name the child, the allergy, and the specific instructions for teach: *

Do any of the listed children have disabilities/special needs? If so, please list the child and the need. This information will be kept c: *

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