2018-19 Children's Ministry Registration Form
Please complete a separate form for each child (toddler-5th grade).
Child's Name (first, middle, last) *
Your answer
Child's Preferred Name
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Grade in 2018-2019 School Year *
Primary Parent Contact's Name *
Your answer
Primary Cell Phone Number *
Your answer
Additional Adult Authorized to Pick Up your Child
Your answer
Please list any allergies?
Your answer
Please check one of the following:
Please acknowledge that you have read the following:
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