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Children's Ministries Registration 2022-2023
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* Indicates required question
Email
*
Your email
Parent/Guardian 1 Last Name
*
Your answer
Parent/Guardian 1 First Name
*
Your answer
Parent/Guardian 2 Last Name
Your answer
Parent/Guardian 2 First Name
Your answer
Marital Status
*
Single
Married
Divorced
Other
Required
Street Address
*
Your answer
City/State Zip
*
Your answer
Home phone
Your answer
Cell Phone
*
Your answer
Preferred Method of Contact
*
Home phone
Cell phone
Email
Text
Required
Photo Release: I understand that pictures will be taken during Children's Ministry activities. I consent to allow Flossmoor Community Church to use photos of my child/children for church publications, both electronically and in print.
*
Yes
No
Required
Child 1 Last Name
*
Your answer
Child 1 First Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Allergies (pls write none, if none)
*
Your answer
Medical or Developmental situations that Children's Ministry Staff or volunteers may need to know (pls write none, if none)
*
Your answer
Grade in school this fall
*
Choose
Pre-School
Kindergarten
First
Second
Third
Fourth
Fifth
Please share any other information that will be important for a teacher to know (i.e. illnesses or deaths in the family, changes in family structure, child is shy or needs some extra attention for any reason, etc)
*
Your answer
Child 2 Last Name
Your answer
Child 2 First Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Allergies
Your answer
Medical or Developmental situations that Children's Ministry Staff and volunteers may need to know
Your answer
Grade in school this fall
Choose
Pre-School
Kindergarten
First
Second
Third
Fourth
Fifth
Please share any other information that will be important for a teacher to know (i.e. illnesses or deaths in the family, changes in family structure, child is shy or needs some extra attention for any reason, etc)
Your answer
Child 3 Last name
Your answer
Child 3 First Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Allergies
Your answer
Medical or Developmental situations that Children's Ministry Staff and Volunteers may need to know
Your answer
Grade in school this fall
Choose
Pre-School
Kindergarten
First
Second
Third
Fourth
Fifth
Please share any other information that will be important for a teacher to know (i.e. illnesses or deaths in the family, changes in family structure, child is shy or needs some extra attention for any reason, etc)
Your answer
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