Children’s Ministry Registration Form

Child's First and Last Name
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Please enter the child's first and last name
Grade
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Please enter the child's grade in school
Age
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Please enter the child's age
Date of Birth
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Please enter the child's date of birth
Allergies
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Please enter any allergies that the child may have - if the child is not allergic to anything to your knowledge, enter NONE.
Parent(s) Names
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Please enter the parent(s) names
Address
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Please enter your home address
City, State & Zip
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Please enter the city, state, and zip code associated with your address.
Phone Number
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Please enter a phone number where we can reach you.
Email Address
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Please enter an email address where we can keep you updated on Children's Ministry information, updates, and events.
Emergency Contact Name
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Please enter the name of someone that we can call if we are unable to reach you in the event of an emergency.
Emergency Contact Phone
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Please enter a phone number that your emergency contact can be reached.
How Did You Hear About Us?
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Please choose the method of how you heard about our Children's Ministry program.