Christian Kids Registration Form 2019-2020
Immanuel Congregational Church
Nursery through 8th grade
Child's Name *
Your answer
Address *
Your answer
School *
Your answer
Grade if applicable *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Gender *
Parent Name *
Your answer
Parent Name *
Your answer
Preferred Contact Email *
Your answer
Main Contact Phone Number *
Your answer
Allergies?
Your answer
Special Needs/Accommodations?
Your answer
Would your child like to occasionally participate as a candle lighter or door greeter at 9:45am as selected?
Does your child wish to participate in the annual Christmas Pageant? *
If yes, would they like a speaking role? *
Would you like to receive seasonal faith formation resources for your family to utilize at home? *
Please note that we will take and publish pictures of your child on our website, newsletter and social media sites. You may opt out by requesting a photo release form from Tracy Gormley.
I give permission for my child to participate in Immanuel Congregational church activities off site during the 2019-202 program year including but not limited to special events in Hartford. I hereby authorize Immanuel Congregational Church, UCC or any of its employees or volunteers and any physicians, nurses, EMT personnel or hospital or emergency facility to provide or arrange for any medical services or treatment to mu child for injuries or illness which may arise during the course of these off site activities. Please sign below. *
Your answer
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