Children's Ministry Registration

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Please provide the following information for your child to participate in Children's Ministries at Hamblen Park Presbyterian Church. Use a separate form for each child.

Child's Name *

Birthdate *

YYYY

Age *

Grade *

Name of School

Home Address *

Allergies/Medications *

Parent/Guardian Name(s) *

Parent/Guardian Email(s) *

Parent/Guardian Phone Number(s) *

Emergency Contact Name *

Emergency Contact Phone Number *

Photo/Video Consent & Release *

I give HPPC permission to use my child's likeness in printed or digital media formats.

Yes

Names of Those NOT Permitted to Pick Up Child from HPPC Activities

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