Central Square Church child info & contact form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please use this form to register your children and youth for Kid's Church and Youth Group at Central Square Church

Parent/ Guardian Info

First and last name(s)

email(s)

phone number(s)

Emergency Contact Info

If emergency contact person is same as above please write "same"

First and last name

Phone

Relationship to child

Child 1

First & Last name

Birthdate

YYYY

Please list food restrictions, allergies, medications, medical needs, other notes:

Child 2

First & Last name

Birthdate

YYYY

Please list food restrictions, allergies, medications, medical needs, other notes:

Child 3

First & Last name

Birthdate

YYYY

Please list food restrictions, allergies, medications, medical needs, other notes:

Please check all that apply

By signing this document I, as the legal guardian of the child listed above, will not hold Central Square Church (CSC) and its volunteers liable for loss, injuries, or damages incurred during the program with the understanding that CSC does its utmost to ensure the safety and well-being of each child. In case of medical emergency, I understand that every effort will be made to contact the parents (guardians) of the participant. I give permission to CSC and its members to administer first aid to the child and obtain medical assistance in the event of an emergency.

Occasionally, we may publish photos of our kids and families ministries for CCFC publications (print and electronic) or social media. Please check here if you do NOT want photos of your child published.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Central Square Church. Report Abuse

Forms