Children Ministry Registration

Children's Ministry Registration 2017 - 2018 School Year

* Indicates required field

Childs Name *

First

Last

Gender *

Male Female

Birthdate *

Grade in School *

Phone Number *

Cell Number *

Email *

Street Address *

City *

State *

Zip *

Parent/Guardian Name *

First

Last

Relationship to Child *

Phone Number *

Parent/Guardians Name *

First

Last

Relationship to Child *

Phone Number *

Other People Authorized to pick me up: *

1. I give permission that photos, videos, and sound bits taken during Children’s Ministry events with my child may be used for GLC events, promotional materials and/or photo albums *

Yes No

3. Does your child bring any medication to church or church activities? If yes, what? *

5. Does your child have any physical, emotional, mental, or behavioral concerns or limitations that our staff should be aware of? If yes, please explain. *

2. Please list all allergies your child has (foods, bee sting, etc.) Are any of them life-threatening: *

4. Has your child ever had: *

Seizures Asthma Homesickness Other

Please explain if other: *

Please share any additional information you would like to share about your child or family with us: *

Submit

Children's Ministry Registration 2017 - 2018 School Year

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