Collegiate Presbyterian Church Child/Youth Visitor Registration and Permission Form 2018-2019
We are glad your child/youth is joining us! We love to have visitors and guests at our Wednesday night programs! In order to make sure your child is safe, we need to have important contact information and permission from you. Please take a moment to fill out this brief form.
Child/Youth Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
Parent/Guardian Name(s) *
Your answer
Emergency Contact Name and Relationship *
Your answer
Emergency Contact Number *
Your answer
Additional Emergency Contact Name and Relationship
Your answer
Additional Emergency Contact Number
Your answer
Friend with whom they are attending *
Your answer
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