Columbus Baptist J.A.M. Registration
Children's Ministry Registration, PRE-K to 6th - 4821 North US 31, Columbus, IN 47201, 812-372-5999
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Email *
Please answer all questions completely.  Thank you.
Parent/Guardians name(s) *
What is your full address? *
What is a phone number where you can be reached? *
What is a secondary phone number that we can use to contact in case we cannot reach you or if there is an emergency? (include name of person) *
List your child(ren)'s full name(s) and birthday(s) starting with your oldest to youngest. This will help us match the responses for the next question.  Ex. Lauren-1  mm/dd/yyyy,  Sarah-2 mm/dd/yyyy,  Becca-3 mm/dd/yyyy, etc.   *
Starting with the oldest to youngest child check the box indicating the grade they will be attending in the Fall of 2021-22 school year.  Each line must be completed.  If needed, swipe to the left for more grade levels or N/A.  If you have less than 4 children use the N/A box to complete unused rows. *
1st Gr.
2nd Gr.
3rd Gr.
4th Gr.
5th Gr.
6th Gr.
Child 1
Child 2
Child 3
Child 4
Besides you, list any additional person(s) who are authorized to pick up your child(ren).  Child(ren) will only be released to you or your authorized person(s).   Provide name(s) and phone number(s).   *
Does your child(ren) have any allergies that we need to know about?  Briefly explain what they are and what would need to be done to help with that allergy. *
Do we have your permission to take photos/video to be used in promotion of this ministry in social media? *
In submitting this form I verify that I am the parent/guardian or authorized by the parent/guardian to register this/these child(ren) for this program.     *
Please type your name below.
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