Children's Ministry Registration Form 2024

2024-25 Children's Ministry Registration Form

PLEASE COMPLETE A SEPARATE FORM FOR EACH CHILD REGISTERED.
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Child's Grade in School as of 8/8/22*
Any Allergies?
Any special needs or concerns you would like to share regarding your child?
Parent Name*

First NameLast Name
Parent's Email Address*
Parent's Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Adult Authorized to pick up your child

First NameLast Name
Additional Authorized Adult Phone Number

Area CodePhone Number
Additional Adult Authorized to pick up your child

First NameLast Name
Additional Authorized Adult Phone Number

Area CodePhone Number
Should be Empty:

2024-25 Children's Ministry Registration Form