Deeper Roots Family Ministry
Family Registration: You only need to complete this form once per semester.
Name of the person filling out this form:
*
First Name
Last Name
Email Address
*
example@example.com
Residential Address
Street Address
Street Address Line 2
City
State
Post Code
Phone Number
*
Please enter a valid phone number.
Adults Attending
*
Rows
Name
Age
Parent/Adult
Parent/Adult
Parent/Adult
Children in your Family
Rows
Name
Age
Allergy Information
Will he/she attend childcare?
Will he/she attend Deeper Roots with you?
Child 1
Yes
No
Unsure
Yes
No
Unsure
Child 2
Yes
No
Unsure
Yes
No
Unsure
Child 3
Yes
No
Unsure
Yes
No
Unsure
Child 4
Yes
No
Unsure
Yes
No
Unsure
Child 5
Yes
No
Unsure
Yes
No
Unsure
If your child(ren) will be attending childcare, is there anything further about your child(ren) you would like us to be aware of? (e.g. allergies, intolerances, medical conditions, disability, developmental delay, preferences):
If none, please write none.
Childcare for Deeper Roots will be at Bethesda E.C church across the street from Meadow Brook Center. We are fully equipped with nursery, preschool room, and programming for school-aged children. Please check your children in at the check-in kiosk on the lower level of the church.
Got it!
If your child(ren) will be attending childcare, please provide emergency contact information:
Rows
Full Name
Contact Number
Emergency Contact 1
Emergency Contact 2
How did you hear about Deeper Roots?
Would you like to be added to our newsletter?
*
Yes
No
PRINT
REGISTER
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