Children's Ministry Registration Form

お使いのブラウザで JavaScript が有効になっていないため、このファイルは開けません。有効にして再読み込みしてください。

Please fill out the following form for your child or multiple children :-).

Google にログインすると作業内容を保存できます。詳細

Child's or Children's names *

Date(s) of Birth *

Parent(s) Name and Contact Information *

Address *

Emergency Contact Name and Relationship *

Emergency Contact Email and Phone Number *

Prefered Medical Facility in Case of Emergency *

Child's or Children's Physician/Pediatrician and Phone Number *

Any allergies or medical conditions we should be aware of? *

Yes

If there are any allergies, what are they?

If there are any medical conditions, what are they and how should we prepare for them?

Is there anything else you would like us to know?

Could we post pictures/videos of your child(ren) to our social media? *

Yes

By signing my child up to be a part of Children's Ministry, I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event that my child is injured or becomes ill. I also understand that St. Alban's strives for equity and inclusion of all children, but adults in charge may limit/adapt/modify activities for my child based on medical information given and the physical/mental exhaustion of any activity. *

Yes

E-Signature (type your full first and last name)

Date

YYYY

送信

フォームをクリア

Google フォームでパスワードを送信しないでください。

このコンテンツは Google が作成または承認したものではありません。不正行為の報告 - 利用規約 - プライバシーポリシー

フォーム