Children’s Ministry - Child Registration Form

Parent/Guardian Name

Email

Phone Number

Parent/Guardian 2

Email

Phone Number

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Child's Name

Gender

Male

Female

Birthdate

Please list any allergies to food, insects, and/or medications (if applicable).

Please list any conditions or special needs that you think we need to be made aware of (if applicable). This information will be kept confidential.

Would you like to register another child?

Yes

No

Child's Name

Gender

Male

Female

Birthdate

Please list any allergies to food, insects, and/or medications (if applicable).

Please list any conditions or special needs that you think we need to be made aware of (if applicable). This information will be kept confidential.

Photography Authorization
In order to share ministry events and updates with the fellowship and to develop future promotional items (i.e. church bulletin boards, website, brochures, etc.), Children’s Ministry will sometimes take video and/or images of the children during Children’s Ministry sponsored events. Please note that no child will be individually named.

Form Completion
By completing this form, I assume all risk of my child/ren and/or myself participating in Children’s Ministry sponsored events. I acknowledge that any activity may pose some risk of personal injury, and that I undertake and assume this risk for myself and my child/ren.

Signature