Children's Ministry Registration

Children's Ministry Registration
Child 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate*

MonthDayYear
Date
School
Grade
Special Instructions:
Allergies, Medical, Behavior, Learning, etc.
Please list who is authorized to pick up this child(ren)*
Guardian Name*

First NameLast Name
Relationship to Child*
Guardian Phone Number*
Please enter a valid phone number.
Email
example@example.com
Guardian Name

First NameLast Name
Relationship to Child
Guardian Phone Number
Please enter a valid phone number.
Email
example@example.com
I, the undersigned parent, consent to my child(ren), attending Kids Connect at Pasadena Assembly of God for any function being photographed.

I agree that Pasadena Assembly of God shall have the right, but not the obligation to use my child's photograph, for their website, or any social media platform, for any other purpose or materials the ministry deems necessary. The child's name will not be used with the photos.

Signature *

Printed Name of Parent/Guardian *

Date*
Child 2

First NameLast Name
Birthdate

MonthDayYear
Date
School
Grade
Special Instructions:
Allergies, Medical, Behavior, Learning, etc.
Child 3

First NameLast Name
Birthdate

MonthDayYear
Date
School
Grade
Special Instructions:
Allergies, Medical, Behavior, Learning, etc.
Child 4

First NameLast Name
Birthdate

MonthDayYear
Date
School
Grade
Special Instructions
Allergies, Medical, Behavior, Learning, etc.
Child 5

First NameLast Name
Birthdate

MonthDayYear
Date
School
Grade
Special Instructions
Allergies, Medical, Behavior, Learning, etc.
Should be Empty: