Kid’s Ministry Registration

NOTE – this form is for guests only. Members, please use the Member Registration Form (click member tab above).

"*" indicates required fields

Which event will you be attending that childcare is needed for?*

Regular Sunday AM Childcare

Regular Sunday PM Childcare

Regular Wednesday PM Childcare

Special Event, Advertised Class, or Bible Study

Please specify the Special Event/Class/Bible Study you need childcare for*

Name of Child*

First Last

Gender*

Male

Female

Date of Birth*

Age*

Grade*

Contact Information

Address*

Street Address City State ZIP Code

Email*

Cell Phone*

Home Phone

List medical, medicines taken on a regular basis, or other information we need to know regarding the care of your child. Please include any medicine or food allergies, anxieties or fears and list specific details. If none, answer N/A.

Medical Information*

List who will be picking up your child:*

Only people listed on this form are allowed to pick up the child. No one younger than 6th Grade and/or not related to you will be allowed to pick up your child. Please remember to bring your security badge with you to pick up your child or you may have to show your driver’s license for identification. Thank you for your cooperation!

Parent Name/Signature*

CAPTCHA

NOTE – this form is for members only. Guests, please use the Guest Registration Form (click guest tab above).

"*" indicates required fields

Which event will you be attending that childcare is needed for?

Regular Sunday AM Childcare

Regular Sunday PM Childcare

Regular Wednesday PM Childcare

Special Event, Advertised Class, or Bible Study

Please specify the Special Event/Class/Bible Study you need childcare for*

Child's Name*

First Middle Last

Gender*

Male

Female

Date of Birth*

School Grade*

Parents/Guardians Names

Parent/Guardian Name 1*

First Last

Address*

Street Address City State ZIP Code

Email*

Cell Phone*

Home Phone

Parent/Guardian Name 2

First Last

Address 2 (if different than above)

Street Address City State ZIP Code

Email 2

Cell Phone 2

Home Phone 2

Medical Information*

Emergency Contacts:*

Name

Phone Number

Dismissal Information: Please list who may pick up your child:*

Parent Name/Signature*

CAPTCHA

Please select the appropriate tab below to fill out the Correct form

Guests, please fill out the Guest Registration Form

Members, please fill out the member Registration Form

NOTE – this form is for guests only. Members, please use the Member Registration Form (click member tab above).

Contact Information

NOTE – this form is for members only. Guests, please use the Guest Registration Form (click guest tab above).

Parents/Guardians Names