Information form - Youth/Children's Ministries
This information if for DCCC use only.  It will not be shared with anyone outside of the church.  
This form is to provide us with contact information for the youth/children in our care.  It will also provide us with any special needs information that we need to be aware of.  Please complete one form for each child.
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Email *
Child name
Child Age
Child date of birth
MM
/
DD
/
YYYY
Parent/Guardian Names
Parent/Guardian Phone number(s):
Parent/Guardian Mailing Address:
Please list any allergies or medical conditions we should be aware of:
Please list persons authorized to drop off and pick up your child:
Do you wish to be added to the email list for Children & Youth Activities?
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