Children's Ministry
General Information
Child's Name *
Your answer
Age *
Your answer
Last grade completed *
Home Address *
Your answer
Primary Phone Number *
Your answer
Family Email Address *
Your answer
Health Information
Health Card Number *
Your answer
Doctor's Name
Your answer
Health Conditions *
Your answer
Medications
Your answer
Guardian Information
Parent/Guardian name(s) *
Your answer
Contact Number *
Your answer
Is this a cell phone? *
Emergency Contact
In the event that we can not contact the parent(s) or guardian(s)
Name *
Your answer
Relationship to the child *
Your answer
Contact number *
Your answer
Correspondance
May we contact you using the following methods?
*
Required
About your Child
Help us get to know your child
What does s/he enjoy? *
Your answer
What is his/her favourite colour? *
Your answer
How does your child feel about coming to our program? *
Will you be attending with your child? *
Do you have any questions for us?
Your answer
Thank you for registering your child in our program! We look forward to seeing you soon.
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