Children's Programming Registration

Parent/Guardian Section
Parent/Guardian Name (1) *
Parent/Guardian Name (1)
Address (1) *
Address (1)
Home Phone (1) *
Home Phone (1)
Cell Phone (1)
Cell Phone (1)
Parent/Guardian Name (2)
Parent/Guardian Name (2)
Address (2) If different
Address (2) If different
Cell Phone (2)
Cell Phone (2)
EMERGENCY CONTACT
Who should we contact first in the case of an emergency *
Who should we contact first in the case of an emergency
Emergency Contact Phone *
Emergency Contact Phone
Alternative Emergency Contact Person
Alternative Emergency Contact Person
Alternative Emergency Phone
Alternative Emergency Phone
Child Section
Child Name (1) *
Child Name (1)
Date of Birth (1) *
Date of Birth (1)
Cell Phone (1)
Cell Phone (1)
Child Name (2)
Child Name (2)
Date of Birth (2)
Date of Birth (2)
Cell Phone (2)
Cell Phone (2)
Child Name (3)
Child Name (3)
Date Of Birth (3)
Date Of Birth (3)
Cell Phone (3)
Cell Phone (3)
Child Name (4)
Child Name (4)
Date of Birth (4)
Date of Birth (4)
Cell Phone (4)
Cell Phone (4)
FINANCIAL CONTRIBUTIONS AND PAYMENTS
Regularly scheduled youth programs are free of charge and open to the community. However, this expense comes out of the operating budget each year. Financial contributions are greatly appreciated! You may give your financial contributions to the director of the program, at the church office or in the offering plate on Sunday mornings. PAYMENT FOR ALTERNATIVE PROGRAMS: We will contact you directly regarding the cost of special events and when payment is due. Please note: We have scholarships available. Please do not let financial reasons hinder your decision to participate. VOLUNTEERS and CHAPERONES do not pay for their child or themselves on any events in order to encourage adult participation and show our appreciation of the time commitment.
FORM SUBMISSION
By pressing the submit button below I am "signing" this document. Look for the "Thank You" screen! If the form remains on the screen, please look for REQUIRED information (Red asterisk *) you may have missed.