Children’s Ministry Registration Form Child's First and Last Name ?Please enter the child's first and last name Grade ?Please enter the child's grade in school Age ?Please enter the child's age Date of Birth ?Please enter the child's date of birth Allergies ?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 ?Please enter the parent(s) names Address ?Please enter your home address City, State & Zip ?Please enter the city, state, and zip code associated with your address. Phone Number ?Please enter a phone number where we can reach you. Email Address ?Please enter an email address where we can keep you updated on Children's Ministry information, updates, and events. Emergency Contact Name ?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 ?Please enter a phone number that your emergency contact can be reached. How Did You Hear About Us? Website Newspaper Friend/Family Other ?Please choose the method of how you heard about our Children's Ministry program.