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Family Night Ministries Child/Teen Registration Form
Wednesdays from 6:15-7:30 (September through March)
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* Indicates required question
In what club/group will your child/teen be involved?
*
Nursery (only for those attending or helping in a class)
Cubbies
Sparks
T&T
Girls of Grace (girls 6th - 12th grades)
Ignite (guys 6th - 12th grades)
What is your child's/teen's last name?
*
Your answer
What is your child's/teen's first name?
*
Your answer
What is your child's/teen's gender?
*
Female
Male
What is your child's/teen's birthdate? (please include the year)
*
MM
/
DD
/
YYYY
What is your child's/teen's current age?
Your answer
What grade will your child/teen be in this year?
Your answer
What is your street address?
Your answer
In what city do you live?
Your answer
In what state do you live?
Your answer
What is your zip code?
Your answer
What is the best phone number to reach you? (nnn-nnn-nnnn)
Your answer
What is an emergency phone number we can have on file? (nnn-nnn-nnnn)
Your answer
What is your email address?
Your answer
What is/are the name/names of the child's/teen's parents or guardians?
*
Your answer
Please list the people who are allowed to pick up your child/teen.
Your answer
Please list the people who are NOT allowed to pick up your child/teen.
Your answer
Please list any allergies or other medical conditions of which we should be aware.
Your answer
Is there anything else about your child/teen of which we should be aware?
Your answer
Where do you consider your church home?
Your answer
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