CHILDREN'S MINISTRY ENROLLMENT FORM

Please fill out this form and click submit.

A form needs to be filled out for every child attending any of our King's children and youth programs. Thank you so much.

Date:

Name of Child

Date of Birth

Age

Address

Mother's Info:

Name of Mother:

Mother's Cell #:

Mother's Address

Father's Info:

Name of Father

Father's cell #:

Father's Address

Pickup & Guardianship Info

What individuals have permission to pick up the child from class?

Who has legal custody of the named child?

Please select all that apply.

Father Mother Both Other

Health and Medical Info

Does your child have any allergies? If so, please list them below.

Are there any health concerns or physical limitations that we need to be aware of? And how can we better suit their needs?

Who do we contact in case of an emergency?

Emergency Contact #:

Does your child still wear diapers?

Please select one option.

Yes No

If so, does King's Chapel Staff and volunteers have the right to change your child's diapers?

Please select one option.

Yes No

If no longer in diapers, does your child need assistance in the bathroom?

Please select one option.

Yes No

Is there anything else that you would like to share that would help your child feel comfortable in class?

Photo Permission

Does King's Chapel staff have permission to take your child's photo/video?

Please select all that apply.

Yes No

If Yes, please check the areas King's Chapel has permission to use those photographs

Please select all that apply.

Social Media (Facebook/Instagram) on the King's Chapel page To share with you, the parent To use on King's Chapel website To use on a King's Chapel promotional video I do NOT give permission for any purpose

Final Contact Info

Email to send confirmation

This address will receive a confirmation email

Phone # to text during service if we need to contact you:

Description

Please fill out this form and click submit.

CHILDREN'S MINISTRY ENROLLMENT FORM

Description

Please Fix the Following