CVBC Kids 2018-2019 Registration
CVBC Kids Sunday School | Sundays (Sept thru May) @ 9 am
CVBC Kids BLAST | Wednesdays (Sept thru April) @ 5:45 - 7:30 pm
Held @ CVBC: 531 E. South Avenue, Chippewa Falls, WI 54729
Contact Heather Clutter at (715) 723-2872 or heatherc@cvbc.net
Ministry Registration
Please select all that apply. If registering more than 4 children, please fill out completely and then start again.
My children will attend the following ministries:
Household Information
Father/Guardian First Name
Your answer
Father/Guardian Last Name
Your answer
Dad Cell
Your answer
Dad Email
Your answer
Mother/Guardian First Name
Your answer
Mother/Guardian Last Name
Your answer
Mom Email
Your answer
Mom Cell
Your answer
Receive text messages?
Address *
Your answer
City, ST, Zip *
Your answer
Primary Phone *
Your answer
Primary Email
Your answer
Emergency Contact Name (OTHER than Parent/Guardian) *
Your answer
Emergency Contact Phone *
Your answer
Children Being Registered
Please list all children (through 5th grade) who will participate in children's ministries. NOTE: All fields required for each child being registered.
CHILD 1
First Name *
Your answer
Last Name *
Your answer
Birthday (mm/dd/yyyy) *
Your answer
Gender *
Grade *
Special Instructions: *
Allergies, Medical, Behavior, Learning?
Your answer
CHILD 2
First Name
Your answer
Last Name
Your answer
Birthday (mm/dd/yyyy)
Your answer
Gender
Grade
Special Instructions:
Allergies, Medical, Behavior, Learning?
Your answer
CHILD 3
First Name
Your answer
Last Name
Your answer
Birthday (mm/dd/yyyy)
Your answer
Gender
Grade
Special Instructions:
Allergies, Medical, Behavior, Learning?
Your answer
CHILD 4
First Name
Your answer
Last Name
Your answer
Birthday (mm/dd/yyyy)
Your answer
Gender
Grade
Special Instructions:
Allergies, Medical, Behavior, Learning?
Your answer
Will you join us?
Are you willing to help out on Sunday mornings? *
If yes, please select all that apply:
Are you willing to help out on Wednesday evenings? *
If yes, please select all that apply:
WAIVER OF LIABILITY & MEDICAL RELEASE FORM
RELEASE OF CHILDREN: By checking I Agree below, you acknowledge that your child(ren) will be released to a parent or well-known relative and understand that CVBC's check-in system has the ability to ensure your child's safety in the event there is an individual who is NOT ALLOWED to pick up your child. *
MEDICAL EMERGENCIES: By selecting I Agree below, you consent to any medical treatment that may be deemed necessary for your child(ren) and understand that efforts will be made to contact you prior to treatment, but in the event you cannot be reached in an emergency, you give permission to the activity leader to make the decisions necessary for treatment. *
PHOTO RELEASE
PHOTOS: By selecting I Agree below, you agree that any photos taken of your child(ren) while participating in church-sponsored functions may be used in church promotional materials. Personal information will not be released. *
By selecting Yes below, you are certifying that you are the parent/legal guardian of the child(ren) listed on this form. You agree to not hold Chippewa Valley Bible Church (CVBC) or the individual leader(s) responsible for any injuries or loss. *
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