Children's Church Registration

Guardian Information

Guardian Name

*

2nd Guardians Name

Address

*

Phone

*

Email

*

This address will receive a confirmation email

Child 1 Information

Child 1 Name

*

Birth Date

*

School / Grade

*

List any Allergies and/or Medications. If this doesn't apply, please type NONE.

*

Any other info we may need to know:

Child 2 Information

Child 2 Name

Birth Date

School / Grade

List any Allergies and/or Medications. If this doesn't apply, please type NONE.

Any other info we may need to know:

Child 3 Information

Child 3 Name

Birth Date

School / Grade

List any Allergies and/or Medications. If this doesn't apply, please type NONE.

Any other info we may need to know:

Child 4 Information

Child 4 Name

Birth Date

School / Grade

List any Allergies and/or Medications. If this doesn't apply, please type NONE.

Any other info we may need to know:

Child 5 Information

Child 5 Name

Birth Date

School / Grade

List any Allergies and/or Medications. If this doesn't apply, please type NONE.

Any other info we may need to know:

Photo Release

*

I DO I DO NOT

grant permission for ONE Church to take photos/video of my child(ren) during church events and to use these images in church publications, website and social media. I understand that photos and videos will NEVER be accompanied by captions or tags that include names or any other identifying information.

Guardian Signature (Type full name)

*

Description

Please fill out this form and click submit.