Registration – Child

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Registration – Child

Names

Child's Name *

First

Last

Parent/Guardian Name *

First

Last

Contact Info

Email *

Cell Phone *

Home or Work Phone *

Address

Address *

Address Line 1

City

State

Zip Code

Mailing Address (if different) *

Address Line 1

City

State

Zip Code

Age Info

Birthdate

Last grade completed in school

Medical & Emergency Info

Medical Information

Emergency Contacts (other than listed above)

Dismissal Information

Other

Does your child attend Sunday School?

If your child is visiting our church, who is he a guest of?

May we have permission to photograph your child?

Yes
No

May we have permission to use your child’s photograph for the purpose of promotion?

Yes
No

Phone