CVBC Kids 2022-2023 Registration

Email address
Ministry Registration

Please select all that apply. If registering more than 4 children, please fill out completely and then start again.
My children will attend the following ministries:
Household Information
Parent 1 Last Name
Parent 1 First Name
Cell
Email
Parent 2 Last Name
Parent 2 First Name
Cell
Email
Receive text messages?

Other
Address
City, ST, Zip
Primary Phone
Primary Email
Emergency Contact Name (OTHER than Parent/Guardian)
Emergency Contact Phone
Children Being Registered

Please list all children (through 5th grade) who will participate in children's ministries. NOTE: All fields required for each child being registered.
CHILD 1
First Name
Last Name
Birthday (mm/dd/yyyy)
Gender
Grade
Special Instructions:
CHILD 2
First Name
Last Name
Birthday (mm/dd/yyyy)
Gender
Grade
Special Instructions:
CHILD 3
First Name
Last Name
Birthday (mm/dd/yyyy)
Gender
Grade
Special Instructions:
CHILD 4
First Name
Last Name
Birthday (mm/dd/yyyy)
Gender
Grade
Special Instructions:
Will you join us?
Are you willing to help out on Sunday mornings?
If yes, please select all that apply:
Are you willing to help out on Wednesday evenings?
If yes, please select all that apply:
WAIVER OF LIABILITY & MEDICAL RELEASE FORM
RELEASE OF CHILDREN: By checking I Agree below, you acknowledge that your child(ren) will be released to a parent or well-known relative and understand that CVBC's check-in system has the ability to ensure your child's safety in the event there is an individual who is NOT ALLOWED to pick up your child.
MEDICAL EMERGENCIES: By selecting I Agree below, you consent to any medical treatment that may be deemed necessary for your child(ren) and understand that efforts will be made to contact you prior to treatment, but in the event you cannot be reached in an emergency, you give permission to the activity leader to make the decisions necessary for treatment.
PHOTO RELEASE
PHOTOS: By selecting I Agree below, you agree that any photos taken of your child(ren) while participating in church-sponsored functions may be used in church promotional materials. Personal information will not be released.
By selecting Yes below, you are certifying that you are the parent/legal guardian of the child(ren) listed on this form. You agree to not hold Chippewa Valley Bible Church (CVBC) or the individual leader(s) responsible for any injuries or loss.
Should be Empty:

Ministry Registration

Household Information

Children Being Registered

CHILD 1

CHILD 2

CHILD 3

CHILD 4

Will you join us?

WAIVER OF LIABILITY & MEDICAL RELEASE FORM

PHOTO RELEASE