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Children's Ministry Registration Form
"[Jesus] said to them, 'Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these.' " Mark 10:14 NIV
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Child's First Name *
Please complete a form for each child.
Child's Last Name *
Please complete a form for each child.
Birth Month *
Birth Date *
Birth Year *
Many Children's Ministry activities are designed for children between the ages of 3 and 11.
Address (street address, city, state, ZIP) *
Mother's Name and Cell Phone Number (with area code) *
If not available, please put N/A.
Father's Name and Cell Phone Number (with area code) *
If not available, please put N/A.
Preferred Email Address *
Authorized People to Pick Up the Child *
Your child will only be released to the parent, guardian, or those who you have authorized above. Nonparents must be 18 years or older.
Emergency Contact *
Full Name and Relationship
Cell Phone Number for the Emergency Contact *
Are there any family situations we should be aware of (for example, custody issues or other matters)? If so, please specify. *
Allergies or Health Conditions? If so, please list them.
Does your child have an Epi-Pen? If so, please list that as well.
Child's Strengths or Interests: *
Check all that apply.
I give my permission for my child to be photographed or filmed. *
I understand that the image may be displayed in church publications, church buildings, or on the church website. I understand that as a precaution my child’s name will not be published or linked with these photographs.
I understand and agree with the following policy. *
It is the goal of the Ephesus SDA Church Children’s Ministry Department to care for your child(ren) to the best of our ability while they are entrusted to us. At any time, we reserve the right to not admit your child into a Children’s Ministry program should there be signs of any communicable disease or sickness (e.g., colds). We also reserve the right to remove children who exhibit extreme or rebellious behavior that negatively impacts our ability to care for all of the children.
By typing my name below, I give permission for my child to attend and participate in Children’s Ministry activities at the Ephesus SDA Church. *
I appreciate that every care will be taken by the leaders and those connected with Children's Ministry, and that they cannot be held responsible for personal injury, loss, or the theft of property affecting my child.
Today's Date *
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