Children's Church Registration Form

Registration for the 2023/2024 School Year

Children's Church Registration

Child's Name *
Address *
Address 1
Address 2

City

State

Zip
Grade *
Age *
Date of Birth *
Name of Parent(s) or Legal Guardian *
Daytime Phone Number
Evening Phone Number
Email *
Name of Emergency Contact if Parent Can't Be Located:
Phone Number
Relationship
List of allergies or medical conditions
Is staff authorized to administer/authorize treatment? *
PARTICIPATION AGREEMENT

I acknowledge that participation in the Children & Yourth Ministries involves risk to the participant and to the parent/guardian, and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, personal injury, exposure to infectious/communicable disease (COVID-19). You agree to abide by the procedures established by the church to protect attendees and staff, and you voluntarily assume the risk that you and/or your family may be exposed while participating in the Children & Youth programs.

Your typed name below represents your signature.
Signature *
Date *
Enter an email address below where we can send confirmation of registration. Thank You
Enter Your Email Address: *