kids ministry registration why church 2016

    Required fields *

    Child Name *

    Birth Date *

    Age *

    Grade *

    Names of Siblings Attending

    Address *

    Parent's Name - primary contact *

    Home Phone *

    Work/Cell Phone

    Parent's Email *


    Parent's Name - secondary contact

    Home Phone

    Work/Cell Phone

    Parent's Email

    Emergency Contact and Phone *

    Allergy/Health Conditions and “I permit my child’s name and food allergy to be posted for Kid's Ministry staff members to see. *
    YesNoN/A

    My child has my permission to attend and participate in Kids Ministry program. (electronic parent signature and date) *