Children's Church Check-In (Visitors)

1
How many children are you registering?* This field is required.
Please Select
Please Select
1
2
3
4
2
Child's Name* This field is required.
First Name
Last Name
3
Last Grade Completed* This field is required.
Please Select
Please Select
Pre-K
Kindergarten
1-2
3-4
5-6
7-8
9-10
11-12
4
Child's Birth Date* This field is required.
Month
Day
Year
5
Medical or other information we may need to know about the child (including food allergies).* This field is required.
6
Child's Name* This field is required.
First Name
Last Name
7
Child's Birth Date* This field is required.
Month
Day
Year
8
Last Grade Completed* This field is required.
Please Select
Please Select
Pre-K
Kindergarten
1-2
3-4
5-6
7-8
9-10
11
9
Medical or other information we may need to know about the child (including food allergies).* This field is required.
10
Child's Name* This field is required.
First Name
Last Name
11
Child's Birth Date* This field is required.
Month
Day
Year
12
Last Grade Completed* This field is required.
Please Select
Please Select
Pre-K
Kindergarten
1-2
3-4
5-6
13
Medical or other information we may need to know about the child (including food allergies).* This field is required.
14
Child's Name* This field is required.
First Name
Last Name
15
Child's Birth Date* This field is required.
Month
Day
Year
16
Last Grade Completed* This field is required.
Please Select
Please Select
Pre-K
Kindergarten
1-2
3-4
5-6
17
Does the child attend Sunday school anywhere?* This field is required.
Yes
No
18
Medical or other information we may need to know about the child (including food allergies).* This field is required.
19
Parent/Legal Guardian Name* This field is required.
First Name
Last Name
20
Phone Number* This field is required.
Area Code
Phone Number
21
Names of Persons to which the child (children) may be released to after children’s church is over.* This field is required.
First Name
Last Name
22
Are there any persons to which the child (children) may NOT be released to?* This field is required.
Yes
No
23
Who may you child (children) NOT be released to?
24
Emergency Contact (other than parent/guardian listed above)* This field is required.
First Name
Last Name
25
Emergency Contact Phone Number* This field is required.
Area Code
Phone Number
26
By clicking the box below, I hereby Give Permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website.
I Agree
Should be Empty: