Child's Name *
Child's Name
Parent/Guardian Name *
Parent/Guardian Name
Address *
Address
Primary Phone *
Primary Phone
Alternate Phone
Alternate Phone
Child's Date Of Birth *
Child's Date Of Birth
Emergency Contact Other Than Listed Above *
Emergency Contact Other Than Listed Above
Child #2 Name
Child #2 Name
If no other children to register please skip to "Dismissal Information" question
Child #2 Date Of Birth
Child #2 Date Of Birth
Child #3 Name
Child #3 Name
Child #3 Date Of Birth
Child #3 Date Of Birth
Child #4 Name
Child #4 Name
Child #4 Date Of Birth
Child #4 Date Of Birth
Dismissal Information- Who May Pick Up Your Child(ren) *
Dismissal Information- Who May Pick Up Your Child(ren)
We ask a parent, guardian, or relative over the age of 18 sign out each child
Who Else May Pick Up Your Child(ren)
Who Else May Pick Up Your Child(ren)
We ask a parent, guardian, or relative over the age of 18 sign out each child
May We Have Permission To Photograph Your Child(ren)
May We Have Permission To use your Child(ren)'s Photograph For The Purpose Of Promotion? *
Person's Name *
Person's Name
By Submitting Your Name You Give Us Permission To Use Your Child(ren)'s Photo Or Video On Our Church Website And/Or Social Media