Children's Ministry Registration (2020)
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Parent/ Guardian Name (1) *
Your answer
Parent/Guardian Name (2)
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
zip code *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relationship to Child *
Your answer
Person 1 authorized to pick up my child *
Your answer
Phone number of person 1 *
Your answer
Person 2 authorized to pick up my child
Your answer
Phone number of person 2
Your answer
List any court-authorized restrictions (Put none if this does not apply) *
Your answer
List Allergies (Put none if no allergies) *
Your answer
List Medications and dosage (Put none if it does not apply) *
Your answer
List any physical or special needs (dietary or other) Put NONE if this does not apply *
Your answer
Crazy Praize - Are you currently registered (children up to 12)? *
Crazy Praize - Would you like to register for this program (children up to 12)? *
Crazy Praize - Does your child play an instrument? *
Crazy Praize - What instrument does your child play?
Your answer
Crazy Praize - List second instrument (if applicable)
Your answer
Crazy Praize: I consent to my child going outside to play during various activities. *
Adventurers Club - Are you currently registered (children up to age 10)? *
Adventurers Club - Would you like to register for the club (children up to age 10)? *
Parent Participation is vital for Children's Ministry. Which Ministry will you be volunteering in this year? *
Yes
No
Children's Church
Adventurers
Crazy Praize
Lower Division Sabbath School
Please list which month (s) we can schedule you to volunteer.
February
March
April
May
June
July
August
September
October
November
December
Children's Church
Adventurers
Crazy Praize
Lower Division Sabbath School
Please list any special Children's Ministry events you would like to volunteer to help. *
Yes
No
Spelling Bee
Reading Challenge
Crazy Praize Performance Days
Adventurer Investiture
Vacation Bible School
End of the Year Banquet
Community Service Events
Sports Outings (Field Days, Park Days)
I consent to my child taking part in the approved programs and activities for Children's Ministries of Mt. Sinai SDA Church (Children's Church, Adventurers, Crazy Praize, Lower Division Sabbath School) *
I consent to my child viewing DVDs rated G or PG. I understand that all material will be previewed by a leader to check suitability. *
Required
I grant permission for my child to be photographed, videotaped, recorded, etc for use in promotional or educational activities of Children's Ministry on the website or via social media of the church. *
I authorize the leaders in charge of the various Children's Ministry programs where it is impractical to communicate with me, to arrange for my child to receive such medical or surgical treatment as the leaders may deem necessary at any time during the activities of Mt. Sinai SDA Children’s Church Ministries. *
I further authorize the use of Ambulance and/or anesthetic by a qualified medical practitioner if in his/her judgement it is necessary. I accept responsibility for payment of all expenses associated with such treatment. *
I agree that the leaders and those connected with Mt. Sinai SDA Children's Ministry cannot be held responsible for personal injury, loss or theft of property affecting my child. *
Electronic Signature (in lieu of my regular signature, printing my name below will serve as my signature of authorization for this form.) *
Your answer
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