Children's Church Registration Form
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Age/Grade Level
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 to Child
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you a member of Greater Friendship?
Yes
No
Visitor
Any Allergies or Medical Conditions?
Yes
No
Please give details of allergies/medical conditions
Is there anyone NOT authorized to pick up your child?
Does your child require any accomadations to participate?
Is there anything else you would like us to know about your child?
Please upload a profile picture of the child
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I, undersigned, agree with the following statements:
I am the parent/guardian of the child indicated above.
If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatment for my child.
I give Greater Friendship Missionary Baptist Church permission to use photographs or videos of my child for church purposes (social media, website, promotional materials, etc.).
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Submit
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