Children's Ministry Registration Form
If you would like to save time during your first visit to Shiloh, please complete this form before you come. If you fill it out by Saturday evening, we will have your child(ren's) information ready on Sunday.
Come to the check-in desk in the gathering area near the refreshments station when you arrive at our Delhi campus.
#1 Parent/Guardian *
Your answer
#2 Parent/Guardian
Your answer
Street Address *
Your answer
City *
Description if needed. Fusce dapibus, tellus ac cursus commodo, tortor mauris condimentum.
Your answer
State *
Your answer
Zip Code *
Your answer
E-mail *
Your answer
Contact Phone During Services *
Your answer
Alternate Phone
Your answer
#1 Child's Name *
Your answer
#1 Child's Gender *
#1 Child's Age *
#1 Child's Grade *
#1 Child's School
Your answer
#1 Child Allergies (or "none") *
Your answer
#2 Child's Name
Your answer
#2 Child's Gender
#2 Child's Age
#2 Child's Grade
#2 Child's School
Your answer
#2 Child Allergies (or "none")
Your answer
#3 Child's Name
Your answer
#3 Child's Gender
#3 Child's Age
#3 Child's Grade
#3 Child's School
Your answer
#3 Child Allergies (or "none")
Your answer
#4 Child's Name
Your answer
#4 Child's Gender
#4 Child's Age
#4 Child's Grade
#4 Child's School
Your answer
#4 Child Allergies (or "none")
Your answer
Photo Consent: I agree to allow Shiloh UMC to use photos, video, and sound recordings of my child(ren) for publicity such as website postings and news articles.
Medical Consent: I consent to any necessary examination, anesthetic, medical diagnosis, surgery, or treatment and/or hospital care rendered to my child(ren) under special supervision and on the advice of any physician licensed to proactive medicine by the state in which they practice during the church event.
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