Children's Ministries Registration
Child's Information:
Child's Name
*
First Name
Last Name
Birthdate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Male
Female
School Grade
*
Please Select
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
Nursery (Parent in building only)
Preschool (Parent in building only)
Kindergarten (Parent in building only)
Children's ministries planning to attend:
Kids4Truth: Wednesday evenings
Sunday School: Sunday mornings
Children's Church: Sunday mornings (Age 2 - Kindergarten only)
Nursery (available for all regular church services - parent must be in the building)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Any medical/physical information our staff should be aware of (including any allergies):
*
Parent/Guardian Information:
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Emergency Information:
Emergency Contact name & phone # (if I cannot be reached):
*
Parent/Guardian Permission:
Dismissal & Transportation Permissions
*
Child can be dismissed from class to find parent on his/her own. (1st grade & older only)
Authorized adult will pick up child (Required for Kindergarten & younger - Please list below)
Child has my permission to ride the church bus/van (Conditional on location - we will contact you.)
Authorized adults allowed to pick up child from class:
Comments or questions:
Parent/Guardian Signature
*
Continue
Continue
Should be Empty: