Parents Information Form 2018-2019

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Southbay Community Baptist Church
448 Francis Drive, San Jose, CA 95133
Contact us at (408) 926-2621 www.scbc.net

Email *

Kid's First Name *

Kid's Last Name *

Kids' Program *

Registration for AWANA is closed.

Nursery / Toddler (under 3yrs old as of Sept 1st 2018)

Sunday Worship (3 year old to 5th grade)

Sunday School (3 year old to 5th grade)

Required

Date of Birth (MM/DD/YYYY) *

Gender *

Boy

Girl

Required

Current School Grade *

(preK - 5th grade)

List all known/possible allergies *

Parent #1's Name *

Parent #1's Phone *

Parent #1's E-mail *

Parent 2's Name

Parent 2's Phone

Parent 2's E-mail

Home Address *

Emergency Information

List 2 people who can be contacted to pick up your child in case of emergencies:

Name #1 *

Relationship to Child *

Cell Phone *

Name #2 *

Relationship to Child *

Cell Phone *

Authorization

In EMERGENCIES requiring immediate medical attention, your child will betaken to the NEAREST HOSPITAL EMERGENCY ROOM. Your signature authorizes the responsible person from SCBC to have your child transported to that hospital and receive treatment.

Signature of Parent/Guardian (Please Type Your Full name) *

Date *

YYYY

Photographs

Photographs are sometimes taken of children’s ministry activities for publicity and promotional purposes, which include, but are not limited to, in-house presentations, church web sites, brochures and newsletters. Children’s names or information are never used without specific permission. Your signature releases SCBC to use photographs of your child as stated above.

Signature of Parent/Guardian (Please Type Your Full name) *

Date *

YYYY

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