Children's Church Check In Form
Is this your first time registering your child for Liberation's Children's Church since July 27, 2025?
*
Yes
No
Parent/Guardian Information
Name
*
First Name
Last Name
Name
First Name
Last Name
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Stay Connected!Would you like to receive updates about upcoming children’s church events, important announcements, and helpful information?
*
Yes, I’m okay with receiving notifications via:
Text Message
Email
No, thank you.
Emergency Contact
Name
Relationship to the Child
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Individual Child Information
1st Child Name
*
Age
*
2nd Child Name
Age
3rd Child Name
Age
4th Child Name
Age
Does your child prefer to be by themselves, or will they work well with others?
Group
Individual
Child’s Interests: (Please check/list all that apply)
coloring/crafts
asking/answering questions
watching videos
puzzles/quiet games
drama/role-play
active/physical games
worship & music
Does the child have any allergies? If yes, please list them below:
Does the participant have any medical condition that we should be aware of? If yes, please explain below:
Additional Information: Please do not hesitate to add anything that would be helpful for us to know!
Terms and Conditions
Photo Release: I give permission for my child’s photo or video image to be used by Liberation for internal and promotional purposes. This may include—but is not limited to—Sunday worship services, digital announcements, the church website content, and social media platforms like Facebook.
*
Yes
No
Parent/Guardian Signature
Date Signed
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: