UNITY BAPTIST CHURCH CHILDREN/YOUTH MINISTRY REGISTRATION FORM
COMPLETE ONE PER CHILD
CHILD'S NAME
*
First Name
Last Name
PRIMARY PARENT NAME
*
First Name
Last Name
PRIMARY PARENT PHONE NUMBER
*
Please enter a valid phone number.
PRIMARY PARENT EMAIL ADDRESS
*
example@example.com
ADDITIONAL AUTHORIZED ADULT TO PICK UP YOUR CHILD
First Name
Last Name
ADDITIONAL AUTHORIZED ADULT PHONE NUMBER
Please enter a valid phone number.
ADDITIONAL AUTHORIZED ADULT EMAIL ADDRESS
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CHILDS DATE OF BIRTH
*
-
Month
-
Day
Year
Date
CHILDS GRADE IN SCHOOL
Please Select
TODDLER
PRE-KINDERGARTEN (PRE-SCHOOL)
KINDERGARTEN
FIRST GRADE
SECOND GRADE
THIRD GRADE
FOURTH GRADE
FIFTH GRADE
SIXTH GRADE
SEVENTH GRADE
EIGHTH GRADE
NINTH GRADE (FRESHMAN)
TENTH GRADE (SOPHMORE)
ELEVENTH GRADE (JUNIOR)
TWELFTH GRADE (SENIOR)
DO WE HAVE PERMISSION TO POST PICTURES OF YOUR CHILD ON SOCIAL MEDIA?
*
YES
NO
WHICH PROGRAM WILL YOUR CHILD BE ATTENDING? (MARK ALL THAT APPLY)
SUNDAY SCHOOL
KIDS OWN WORSHIP (KOW)
CLUB 185 KIDS
UNITED YOUTH
DOES YOUR CHILD HAVE ANY ALLERGIES WE NEED TO BE AWARE OF?
FOOD, INSECTS, MEDICINES, ETC.
ANY SPECIAL NEEDS YOU WOULD LIKE TO SHARE WITH THE CHURCH REGARDING YOUR CHILD? (THIS INFORMATION WILL BE KEPT CONFIDENTIAL AND WILL ONLY BE SEEN BY NECESSARY STAFF MEMBERS.)
Please do not allow your children to bring things such as cell phones, tablets, toys or other items that may be a distraction to themselves or others around them. We will have a designated location for your child to put these items should they have them with them when they arrive at church. This location will be under constant supervision so you will not need to worry about the items left there. If you need to contact your child during service, please call or text Steve Zimmerman at 618-267-9438, or by using the "TeamReach" app. We appreciate your help and assistance with this.
ACKNOWLEDGEMENT TO READING THE ABOVE
YES
NO
CHURCH BUS PERMISSION
IF YOUR CHILD WILL BE RIDING THE CHURCH VAN/BUS TO ANY OF THE ABOVE LISTED PROGRAMS PLEASE MESSAGE OUR DRIVERS THROUGH THE "TEAMREACH" APP. TEAMREACH APP GROUP CODE: "UnityClub185"
WILL YOUR CHILD BE RIDING THE CHURCH BUS?
*
YES
NO
I HEREBY GIVE PERMISSION FOR MY CHILD, LISTED ABOVE, TO RIDE THE UNITY BAPTIST CHURCH BUS TO ATTEND CHURCH ACTIVITIES. I UNDERSTAND THAT MY CHILD WILL BE UNDER ADULT SUPERVISION. I FURTHER UNDERSTAND THAT IN SIGNING THIS REGISTRATION, I RELEASE UNITY BAPTIST CHURCH, STAFF, AND VOLUNTEERS FROM ANY LIABILTY PAST, PRESENT, OR FUTURE. I AUTHORIZE THE STAFF OR DESIGNATED MEDICAL PROFESSIONALS TO ADMINISTER EMERGENCY MEDICAL ASSISTANCE IF I CANNOT BE CONTACTED.
Signature
*
By signing here, I agree to the above statements.
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