WCC Children’s Ministry Online Registration
Register your child for children's ministry at Waushara Community Church
Student Information
Child’s First Name: *
Your answer
Child’s Last Name: *
Your answer
Grade Entering: (Note: Children are placed in classes based on their age as of September 1st .) *
Gender: *
Your answer
Birthdate: *
MM
/
DD
/
YYYY
My child has received Jesus as Savior: *
Medical Concerns?: *
Explain medical concerns:
Your answer
Learning Issues?: *
Explain learning issues:
Your answer
Food Allergies?: *
Explain food allergies:
Your answer
Family Information
Parents/Guardian First Name: *
Your answer
Parents/Guardian Last Name: *
Your answer
Street Address: *
Your answer
PO Box:
Your answer
City: *
Your answer
State: *
Your answer
Zip: *
Your answer
Home Phone: *
Your answer
Cell Phone:
Your answer
Email:
Your answer
Relationship to Student: *
Your answer
I give permission for my child’s picture to be used in promoting WCC’s Children’s Ministry: *
To ensure child safety, I agree to accompany my child (Preschool 2 through Grade 3) both to and from my child’s classroom: *
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