Youth and Family Ministry Registration Form
2023-2024
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Any Allergies or Medical Conditions?
Yes
No
Please give details
Do you want to add something about your child?
I, undersigned, agree with the following statements:
I am the parent/guardian of the child indicated above.
I am giving my permission to take my child's pictures for classroom projects and post them on the church website.
I do not give permission for my child to be photographed.
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Submit
Should be Empty: