CC KIDS REGISTRATION

Children's Ministry Registration

Welcome! We look forward to meeting you and your child(ren)! Please fill out this form, all information shared will be kept confidential. Thank you!
Child #1
First Name*
Last Name*
Birth Date*

MonthDayYear
Grade*
Gender*

MaleFemaleOther
Allergies or medical conditions?
Child #2
First Name
Last Name
Birth Date

MonthDayYear
Grade
Gender

MaleFemaleOther
Allergies or medical conditions?
Child #3
First Name
Last Name
Birth Date

MonthDayYear
Grade
Gender

MaleFemaleOther
Allergies or medical conditions?
Child #4
First Name
Last Name
Birth Date

MonthDayYear
Grade
Gender

MaleFemaleOther
Allergies or medical conditions?
Family Information
Address*
City*
State*
Zip*
Home Phone

Area CodePhone Number
Parent/Legal Guardian*
Relation*
Cell Phone*

Area CodePhone Number
E-mail*
We communicate mostly via e-mail.
Parent /Legal Guardian 2
Relation 2
Cell Phone 2

Area CodePhone Number
Email
Other Information
Emergency contact/alternate pick-up
Leave blank, if no other person may pick up your child.
Phone Number

Area CodePhone Number
Emergency contact/alternate pick-up
Leave blank, if no other person may pick up your child.
Phone Number

Area CodePhone Number
Is there any additional information you would like us to know about your child(ren)? This information will be kept in confidence.
From time to time we take pictures during Sunday School and other Church activities. We would like your permission to use these pictures on our website and in house (i.e. bulletin board or projector screen). We will never reference your child by full name or provide any specific information regarding your child. We also will never sell these pictures; we will use them exclusively for College Church’s purposes. Please take a moment to let us know your preferences regarding our use of photos of your child(ren):
Do we have permission to use your child's photos for church related purposes:*
I understand that in the event of a medical emergency involving my child, every reasonable effort will be made to locate me for any needed medical intervention. However, in the event that my child needs immediate medical attention in a life-threatening situation, I hereby authorize CC and its employees, officers, directors, and volunteers to secure necessary medical care, including the administration of an epipen.

I understand that by signing this form I am waiving rights to bring a claim or cause of action against College Church and its employees, officers, directors, and volunteers, involving any and all liability or injury of any kind sustained by my child while participating in any activity directed or sponsored by College Church.
Signature*

Clear
Electronic signature, please initial*
Should be Empty:

Children's Ministry Registration

Child #1

Child #2

Child #3

Child #4

Family Information

Other Information