CHILDREN'S INFORMATION

Child's Full Name

Email Address

Address

City

State

Zip Code

Date of Birth

Age Age456789101112131415161718Other

Phone Number

Grade as of August 2025 Grade as of August 2025Pre-KKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthNinthTenthEleventhTwelfthGraduated, Dropped, or Attending Non-Traditional School

Do you receive texts? Do you receive texts? Yes No I would like to be informed of future events. I would like to receive inspirational messages.

Name of Parent or Guardian

Please list any medications, allergies, or disabilities we may need to know while caring for your child. (This information will be kept private.)

Please list an emergency contact and phone number.

Please list any siblings. (You will need to submit a separate form for each one.)

Do you consent to photos or videos of your child being shared on our church website, Facebook page, You Tube, or any other social media? Do you consent to photos or videos of your child being shared on our church website, Facebook page, You Tube, or any other social media? No Yes