Children and Youth Registration Form
Hello Parents! Please take a moment to fill out the 2018-19 Registration Form for any of Old South's children's or youth programs, including Worship Workshop/Sunday School, nursery, and youth events. Please note that we do not share any information, this is just for your child's safety and care.
Family Information
Name of Parent/Guardian 1 *
Your first and last name
Name of Parent/Guardian 2
First and last name
Home Phone Number *
Please include area code
Home Address *
Street, City, Zip
Parent 1 Email Address *
Parent 2 Email Address
Parent 1 Cell Phone *
(Or first number to call in case of emergency)
Parent 2 Cell Phone *
(Or second number to call in case of emergency)
Additional Emergency Contact (in case parents cannot be reached) *
First & Last Name, Phone, Relation to child
Photography Permission *
Please type your initials below to agree, and/or specify any exclusions to the following statement: I give my permission for photographs or video of my child to be used by the church for worship services (slide shows), printed visuals (bulletin boards, brochures), digital publicity (email updates, the church website, the church Facebook page, youtube), at the discretion of Pastor Carol and other trusted church leaders. I understand that I may request at any time for a specific image to be removed from such places. I also understand that the worship service is taped and distributed to the local cable channel.
Child 1 Info
Please register your children in age order, from youngest to oldest
Child 1 Name *
First and Last
Child 1 Date of Birth *
Child 1 Special Info *
Allergies, medical conditions, learning disabilities, dietary restrictions, or anything else we should be aware of.
Child 1 Grade *
For the 2018-19 School Year
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