Parent / Guardian Information

Father's First Name Father's Last Name

Street Address City State Zip

Home Phone (XXX-XXX-XXXX) Cell Phone (XXX-XXX-XXXX)

Mother's First Name Mother's Last Name

Street Address City State Zip

Home Phone (XXX-XXX-XXXX) Cell Phone (XXX-XXX-XXXX)

Would you like to receive Children's Ministry updates by email? Yes No

Family email Child/Children live with Both Parents Mom Dad Grandparents Guardian Other

Emergency Contact (If both parents are unavailable)

Name * Relationship to child*

Home Phone (XXX-XXX-XXXX) Cell Phone (XXX-XXX-XXXX)

Individual Child Information (children birth - 4th grade)

1.) Child's Name* Date of Birth* (XX-XX-XXXX)

Baptismal Date (XX-XX-XXXX) Grade School

List any chronic condition/illness: (if None, Please state) *

List any allergies and severity of reations: (if None, Please state) *

Anything else your child's teacher should know

Programs child will be involved in: (Please be careful as you cannot unselect without resetting the whole form)

Sunday School Childrens Church Nursery Kingdom Kids Childrens Choir Bell Choir

Other

2.) Child's Name Date of Birth (XX-XX-XXXX)

Baptismal Date (XX-XX-XXXX) Grade School

List any chronic condition/illness: (if None, Please state)

List any allergies and severity of reations: (if None, Please state)

Anything else your child's teacher should know

Programs child will be involved in: (Please be careful as you cannot unselect without resetting the whole form)

Sunday School Childrens Church Nursery Kingdom Kids Childrens Choir Bell Choir

Other

3.) Child's Name Date of Birth (XX-XX-XXXX)

Baptismal Date (XX-XX-XXXX) Grade School

List any chronic condition/illness: (if None, Please state)

List any allergies and severity of reations: (if None, Please state)

Anything else your child's teacher should know

Programs child will be involved in: (Please be careful as you cannot unselect without resetting the whole form)

Sunday School Childrens Church Nursery Kingdom Kids Childrens Choir Bell Choir

Other

4.) Child's Name Date of Birth (XX-XX-XXXX)

Baptismal Date (XX-XX-XXXX) Grade School

List any chronic condition/illness: (if None, Please state)

List any allergies and severity of reations: (if None, Please state)

Anything else your child's teacher should know

Programs child will be involved in: (Please be careful as you cannot unselect without resetting the whole form)

Sunday School Childrens Church Nursery Kingdom Kids Childrens Choir Bell Choir

Other