Glen Ellyn Evangelical Covenant Church Children's Ministry Registration

Glen Ellyn Evangelical Covenant Church Children's Ministry Registration

2024-2025
Child Information
How many children are you registering?*
Please register all of your children, ages birth through grade 5 on this form.
First Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade *
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GEECC my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Glen Ellyn Evangelical Covenant Church from liability in acting on my behalf in this regard. *
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Children's Ministry. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Second Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade*
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GEECC my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Glen Ellyn Evangelical Covenant Church from liability in acting on my behalf in this regard. *
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Children's Ministry. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Third Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade *
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GEECC my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Glen Ellyn Evangelical Covenant Church from liability in acting on my behalf in this regard.*
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Children's Ministry. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Fourth Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade *
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GEECC my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Glen Ellyn Evangelical Covenant Church from liability in acting on my behalf in this regard.*
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Children's Ministry. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Take Photo of Child 1
Take Photo of Child 2
Take Photo of Child 3
Take Photo of Child 4
Parent/Guardian Contact Information
Parent/Legal Guardian Name 1*

First NameLast Name
Contact Phone Number 1*
Contact Email 1*
example@example.com
Contact Address 1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Legal Guardian Name 2

First NameLast Name
Contact Email 2
example@example.com
Contact Phone Number 2
Contact Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are there any persons to which the child (children) may NOT be released to?*

YesNo
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)

First NameLast Name
Emergency Contact 1 Phone Number
Relationship to child(ren)
Media Release

In order to share the good news of the mission and ministry of Glen Ellyn Evangelical Covenant Church, we occasionally use images (photo/video) of students in classrooms or during special programs, or sent to GEECC by parents/guardians. These images may be shared on church bulletin boards, newsletters, in local newspapers or other printed materials, on our website, social media (email communications, live-stream events, Facebook, Instagram, YouTube, etc.), or in presentations during worship. If you are comfortable with the use of your child(ren)’s and/or youth(s)’s images for these purposes, please indicate below.
I hereby give permission for Glen Ellyn Evangelical Covenant Church to take and use images of my child(ren)/youth (photo or video) taken during church-related activities, or shared by me with GEECC staff, for church purposes only as described above. No children/youth will be identified by name. I understand that I will be contacted for special permission should any photo be considered for use other than described above.*

I AgreeI Disagree
Pickup and Dismissal Guidelines

To support our dedicated volunteers and ensure a smooth process, please review and agree to the following pickup procedures for your child(ren) in the GEECC Children's Ministry: * When Sunday School is in session, I will pick up my child(ren) no later than 11:55 AM from the gym. * When there is no Sunday School, I will pick up my child(ren) no later than 10:55 AM from the classroom. I acknowledge that my child(ren) will not be dismissed without a parent or authorized person present. By agreeing to this clause, I help ensure a safe and organized environment for all participants.
Signature*

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Glen Ellyn Evangelical Covenant Church Children's Ministry Registration

Child Information

First Child

Second Child

Third Child

Fourth Child

Parent/Guardian Contact Information

Media Release

Pickup and Dismissal Guidelines