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Pulse Kids - Wednesday Night Ministry
6:30-7:45 pm
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* Indicates required question
V What is your child's full name?
*
Your answer
Child's Age
*
Your answer
Allergies
Your answer
Parent or Guardian Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Emergency Contact Number
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Your answer
2nd Emergency contact number
(Another number we may call in addition to number above.)
*
Your answer
Will your child be a bus rider?
*
Yes
No
Other:
If your child is a bus rider, please provide the address he/she should be picked up and dropped off.
Your answer
By selecting Yes, I give Richmond Assembly of God my permission to post my child's photograph on the church website and social media.
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No
Other:
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