FAMILY CHECK-IN FORM
Which campus do you attend on Sundays?
*
Summerlin (Buffalo & Vegas Dr.)
North (Craig & Simmons)
Which service are you checking in for?
*
9:00am
10:30am
Wednesday Night Youth Group
PARENT/GUARDIAN INFORMATION
Let's start by getting your information!
Parent/Guardian Name
*
First Name
Last Name
Please select the option that applies to you
*
Mother
Father
Grandmother
Grandfather
Legal Guardian (Female)
Legal Guardian (Male)
Other
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Parent/Guardian Date of Birth
/
Month
/
Day
Year
Date
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to add another parent?
YES
NO
Parent/Guardian Name
*
First Name
Last Name
Please select the option that applies to you
*
Mother
Father
Grandmother
Grandfather
Legal Guardian (Female)
Legal Guardian (Male)
Other
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Parent/Guardian Date of Birth
/
Month
/
Day
Year
Date
Is the address for this parent/guardian the same as listed above?
*
YES
NO
Parent/Guardian Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CHILDREN INFORMATION
Please include ALL children under the age of 18 in this section of the form!
How many children do you have in your household (under the age of 18)?
Child 1
Full Name (Child 1)
*
First Name
Last Name
Gender (Child 1)
*
Male
Female
Birth Date (Child 1)
*
/
Month
/
Day
Year
Date
Age (Child 1)
*
Grade (Child 1)
*
Please Select
Not School Age
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Allergies & Medical Information (Child 1)
Child 2
Full Name (Child 2)
*
First Name
Last Name
Gender (Child 2)
*
Male
Female
Birth Date (Child 2)
*
/
Month
/
Day
Year
Date
Age (Child 2)
*
Grade (Child 2)
*
Please Select
Not School Age
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Allergies & Medical Information (Child 2)
Child 3
Full Name (Child 3)
*
First Name
Last Name
Gender (Child 3)
*
Male
Female
Birth Date (Child 3)
*
/
Month
/
Day
Year
Date
Age (Child 3)
*
Grade (Child 3)
*
Please Select
Not School Age
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Allergies & Medical Information (Child 3)
Child 4
Full Name (Child 4)
*
First Name
Last Name
Gender (Child 4)
*
Male
Female
Birth Date (Child 4)
*
/
Month
/
Day
Year
Date
Age (Child 4)
*
Grade (Child 4)
*
Please Select
Not School Age
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Allergies & Medical Information (Child 4)
Child 5
Full Name (Child 5)
*
First Name
Last Name
Gender (Child 5)
*
Male
Female
Birth Date (Child 5)
*
/
Month
/
Day
Year
Date
Age (Child 5)
*
Grade (Child 5)
*
Please Select
Not School Age
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Allergies & Medical Information (Child 5)
Child 6
Full Name (Child 6)
*
First Name
Last Name
Gender (Child 6)
*
Male
Female
Birth Date (Child 6)
*
/
Month
/
Day
Year
Date
Age (Child 6)
*
Grade (Child 6)
*
Please Select
Not School Age
Pre-K
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Allergies & Medical Information (Child 6)
How did you hear about us?
Please Select
Online
Social Media
Friend
Other
Please let us know if you are interested in...
Please Select
Membership
Baptism
Joining a group
Joining a serve team
Please note: Photography and video recording may be in progress while you are here, and entry into the facility signifies your release and consent to the possibility that your image may be used by Shadow Hills Church for promotional purposes.
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