First Presbyterian Church - One Child Information Form
Form to gather information for Membership Database and for Church Directory
Parent or Guardian
Adult family member name(s)?
Enter family name(s) such as Bill Smith or Rose Smith, Bill & Rose Smith or, if different last names, Rose Smith & Bill Jones.
Your answer
Family Contact Information
Use "One Adult Information Form" to provide family contact information.
Profile Information for Child Living at Home
Child's first (given) name, middle name or initial, and last name?
Your answer
If child has a preferred name you would like us to use in place of his/her given name, please enter it here.
Your answer
What is child's relationship to you?
Son, daughter, grandchild, niece, nephew, etc.
Your answer
Child's birth date?
MM
/
DD
/
YYYY
If child has been baptized, please enter baptism date or approximate date.
MM
/
DD
/
YYYY
What grade in school is child currently enrolled?
If it is summer and school is currently not in regular session, enter grade child will attend in the coming fall.
Your answer
Emergency contact first and last name, relationship, and phone number?
There may be more than one emergency contact. Please list the primary contact first.
Your answer
Please list those, including parents, who are authorized to pick up this child from Sunday school and other church or church related youth events.
Please give first and last name, relationship, and phone numbers (home and/or cell).
Your answer
Please list child's allergies.
If none, enter None.
Your answer
Please list child's medical conditions.
If none, enter "None".
Your answer
Please list prescription drugs that child takes.
If none, enter "None".
Your answer
Submit form
Carefully check the information you entered above, make changes as necessary, then click the SUBMIT button.
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