Children's Ministry: Grade K-6

Registration Form

If you have never registered your child(ren), please complete the following form:

	(1) Child's Name:
Select one: Boy Girl
	Age:
	Grade:
	Birthday:
	Special Needs:
	(2) Child's Name:
Select one: Boy Girl
	Age:
	Grade:
	Birthday:
	Special Needs:
	(3) Child's Name:
Select one: Boy Girl
	Age:
	Grade:
	Birthday:
	Special Needs:
	(4) Child's Name:
Select one: Boy Girl
	Age:
	Grade:
	Birthday:
	Special Needs:
*	Parent/Guardian Name(s):
*	Mailing Address:
*	Postal Code:
*	Home Phone:
*	Cell (for Emergency):
*	Emergency Contact:
*	Email (for notification purposes):
	Allergies or any other Medical Concerns:
	Other information that would be helpful as we care for your child(ren):
Over the course of the year, the church may publish student work, photos, or other information to highlight their activities or achievements. Information may be published on church bulletin boards, newsletters, and the church’s website.
*	Permission to Publish	YesNo
*	Enter the code displayed: