PLEASE COMPLETE GENERAL FAMILY INFORMATION AND INDIVIDUAL CHILD INFORMATION FOR
SCHOOL YEAR 2010-2011
Field Explanations:
Adults bringing children to Children’s Ministries activities
This is the name and address for the responsible person(s) who regularly bring children to church when those children attend (even if it is sporatically). This includes parents, grandparents, other families member and friends.
*Name:
*Street Address:
*City: *State: *Zip Code:
Family Number
This is the number Children’s Ministries has assigned to your family to help us communicate with you during services, if necessary. It is also assigned for security purposes. The number appears on your Children’s Ministries photo ID or the Elementary ID, which has your name and number.
Family Number:
Relationship to child/ren
What is your relationship to the children you bring to Children’s Ministries activities? Check one.
Parent Grandparent(GP) Other Family Member Friend
Legal Guardian Other, please explain:
Home Phone (Land line)
Please give us your home phone number if it is a land line.
Home Phone:
Cell Phones
Please give us the cell phone number(s) that would allow us to quickly get in touch with you during a Children’s Minstries activity.
Cell Phone(s): (F) (M)
Email Address
If you have more than one email address, please list the one to which we could send future Children’s Ministries information.
Email: I do not have email
Your School District
Even if your children are infants, please give us the name of the school district in which you live.
School District:
Address of child/ren, if different from above
If the children you bring to church reside at an address different from your own, please list it here.
Child Information Form for School Year 2010-2011
Child’s Name: Gender: M F Child’s Birthdate:
School Name: OR Home school Grade/Class for 2008-2009: Child’s Name: Gender: M F Child’s Birthdate:
School Name: OR Home school Grade/Class for 2008-2009:
School Name: OR Home school Grade/Class for 2008-2009
Allergies for each child:
Medical Information or Special Needs or Instructions for each child:
Thank you for completing this information. Please click the Submit button to finish.