First Time Visitor

First Time Visitor
We are glad you joined us for worship.

Fill out the form below so we can stay in contact with you. -

Central Baptist Church

2842 Washington Boulevard St. Louis, MO 63103

314-533-0747

askcentral@cbcstl.org

Reverend Anthony L. Riley

M. Div., D. Min.; Senior Pastor

Office Hours: Monday - Thursday 8 am - 5 pm

Making Disciples...Transforming Lives!
Today's Date*

MonthDayYear
Prefix*
Please select
First Name*
Last Name*
Are you a first time visitor?*
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Would you like to stay connected and receive our e-newsletters?

YesNo
Would you like to stay connected and receive our text message alerts?

YesNo
Central Children’s Programs COVID-19 Liability Release Waiver and Intake Form

In this section you will enter the information for the child or children
How many children under the age of 17 will be attending Church with you?*
What children's program would you like the child or children to attend?*

Nursery (Ages 0-4 yo)Youth Hour (Ages 13-17 yo)Children's Church (Ages 5-12 yo)None
Parent or Guardian Name

First NameLast Name
Parent or Guardian(s) Phone Number
Parent or Guardian(s) Email
example@example.com
Parent or Guardian(s) Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this your child or children’s 1st time attending the Nursery?*
Is this your child or children’s 1st time attending Children’s Church?*
Is this your child or children’s 1st time attending Youth Hour?*
Child Information:Full Name Age Relationship
Child Information:Full Name Age Relationship
Child Information:Full Name Age Relationship
Child Information:Full Name Age Relationship
Child Information:Full Name Age Relationship
Child Allergy Information*
Please list any allergies your child may have here
Emergency Contact: Full Name* Relationship: blank* Phone Number: Phone Number*
Child Pick Up Authorization

In this section you will enter the pick up information for the child or children
Main Pick-Up Person: Full Name* . Relationship: Relationship to the Child* . Phone Number: Phone Number*
Additional Pick-Up Person: Full Name . Relationship: Relationship to the Child . Phone Number: Phone Number
Additional Pick-Up Person: Full Name . Relationship: Relationship to the Child . Phone Number: Phone Number
Any person(s) NOT authorized to pick up your child(ren)?
Should be Empty:

First Time Visitor

Central Children’s Programs COVID-19 Liability Release Waiver and Intake Form

Child Pick Up Authorization