Salem Heights Church Children's Ministry Check-In Registration
Parent/Guardian Name *
Your answer
2nd Parent/Guardian
Your answer
Parent/Guardian Phone Number *
This will be the number used to check in your child(ren) each week.
Your answer
2nd Parent/Guardian Phone Number
Your answer
Parent/Guardian E-Mail Address *
Your answer
2nd Parent/Guardian E-Mail Address
Your answer
Home Address *
Please include City and Zip Code
Your answer
Child Name *
(First, Last)
Your answer
Date of Birth *
(ex: 00/00/0000)
Your answer
Grade in School *
Gender *
Medical Notes
Any medical related items we should be aware of?
Your answer
Child Name (2)
Your answer
Date of Birth
Your answer
Grade in School
Gender
Medical Notes
Any medical related items we should be aware of?
Your answer
Child Name (3)
Your answer
Date of Birth
Your answer
Grade in School
Gender
Medical Notes
Any medical related items we should be aware of?
Your answer
Child Name (4)
Your answer
Date of Birth
Your answer
Grade in School
Gender
Medical Notes
Any medical related items we should be aware of?
Your answer
Child Name (5)
Your answer
Date of Birth
Your answer
Grade in School
Gender
Medical Notes
Any medical related items we should be aware of?
Your answer
Submit
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