PDF Form

MCBC Children's Ministry

2022/2023 Information Form
Please click on the drop-down tabs and fill every field.

1st Parent/Guardian Section
1st Parent/Guardian Name

Prefix First Name Middle Name Last Name Suffix
1st Parent/Guardian Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
1st Parent/Guardian Phone Number
Please enter a valid phone number.
1st Parent/Guardian Email
example@example.com
I prefer that you contact me via blanks.

2nd Parent/Guardian Section
2nd Parent/Guardian Name

Prefix First Name Middle Name Last Name Suffix
2nd Parent/Guardian Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
2nd Parent/Guardian Phone Number
Please enter a valid phone number.
2nd Parent/Guardian Email
example@example.com
I prefer that you contact me via blanks.

1st Child
Child's Full Name

First Name Middle Name Last Name Suffix
My child attends shirt size school and is in the grade level grade.
Allergies/Other Medical Notations
Child's Date of Birth

Month Day Year
Date
Child's T-shirt Size: shirt size.

2nd Child
Child's Full Name

First Name Middle Name Last Name Suffix
My child attends shirt size school and is in the grade level grade.
Allergies/Other Medical Notations
Child's Date of Birth

Month Day Year
Date
Child's T-shirt Size: shirt size.

3rd Child
Child's Full Name

First Name Middle Name Last Name Suffix
My child attends shirt size school and is in the grade level grade.
Allergies/Other Medical Notations
Child's Date of Birth

Month Day Year
Date
Child's T-shirt Size: shirt size.

4th Child
Child's Full Name

First Name Middle Name Last Name Suffix
My child attends shirt size school and is in the grade level grade.
Allergies/Other Medical Notations
Child's Date of Birth

Month Day Year
Date
Child's T-shirt Size: shirt size.

Security Information
Is there anyone we should not release your child(ren) to? Is there anything we should be aware of?
In the case of an emergency and a parent/legal guardian cannot be reached, whom should we contact?
Please provide NAME, PHONE, and RELATONSHIP in the above field.

Photo/Video Consent and Release
Photo/Video Consent and Release: Please read and initial if you consent. I hereby authorize MINISTERS AND VOLUNTEERS of the event to take photographs, recordings, and/or videos (whether electronic, digital, or otherwise) of Participant in connection with the Activity, and I hereby consent to the use, reproduction, and publication of such images by the Church in connection with the promotion and publicity of the activities of Mount Carmel Baptist Church, including, without limitation, publication of such images on the Church website. I, individually and in my capacity as parent/legal guardian of Participant, hereby waive any right to inspect or approve the actual use by Mount Carmel Baptist Church of any such image of Participant. Such images of Participant shall be the sole property of Mount Carmel, and I, individually and in my capacity as parent/legal guardian of Participant, acknowledge and agree that neither I nor Participant shall be entitled to any compensation whatsoever should any such images of Participant be used by Mount Carmel Baptist Church.

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