Canaan's Nest Registration Form
Please complete this form by midnight on the Saturday before to ensure your child has a spot in Children's Church on the following Sunday morning.
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Child's Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Primary Guardian's Name *
Cell Number *
Address (Please include city, state, and zip) *
Secondary Guardian's Name *
Cell Number *
Address (Please include city, zip, and state) *
Primary Alternate's Name (MUST BE < 16) *
Primary's Alternate's Cell Number *
Secondary Alternate's Name (MUST BE < 16) *
Secondary Alternate's Cell Number *
I understand that only the guardians and alternates listed on this form are authorized to pick up my child. *
Required
Does your child have any allergies? *
Please explain your child's allergies. *
Does your child have any medical considerations we should be aware of? *
Please explain your child's medical needs. *
Dietary restrictions *
I give permission for Mt. Canaan to use my child's photograph publicaly to promote children's church. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or compensation will be payable to me by reason of such use.  *
Required
I understand that Mt. Canaan is not liable in case of an accident during activities related to Mt. Canaan Eaglets, so long as standard safety procedures have been taken. *
Required
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