Children's Ministry Registration (2020)

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Email *

Child's First Name *

Child's Last Name *

Date of Birth *

YYYY

Age *

Parent/ Guardian Name (1) *

Parent/Guardian Name (2)

Primary Phone Number *

Secondary Phone Number

Street Address *

City *

State *

zip code *

Emergency Contact Name *

Emergency Contact Phone Number *

Emergency Contact Relationship to Child *

Person 1 authorized to pick up my child *

Phone number of person 1 *

Person 2 authorized to pick up my child

Phone number of person 2

List any court-authorized restrictions (Put none if this does not apply) *

List Allergies (Put none if no allergies) *

List Medications and dosage (Put none if it does not apply) *

List any physical or special needs (dietary or other) Put NONE if this does not apply *

Crazy Praize - Are you currently registered (children up to 12)? *

Yes

Crazy Praize - Would you like to register for this program (children up to 12)? *

Yes

Already registered

Crazy Praize - Does your child play an instrument? *

Yes

Crazy Praize - What instrument does your child play?

Crazy Praize - List second instrument (if applicable)

Crazy Praize: I consent to my child going outside to play during various activities. *

Yes

Adventurers Club - Are you currently registered (children up to age 10)? *

Yes

Adventurers Club - Would you like to register for the club (children up to age 10)? *

Yes

Parent Participation is vital for Children's Ministry. Which Ministry will you be volunteering in this year? *

Yes

Children's Church

Adventurers

Crazy Praize

Lower Division Sabbath School

Please list which month (s) we can schedule you to volunteer.

February

March

April

May

June

July

August

September

October

November

December

Children's Church

Adventurers

Crazy Praize

Lower Division Sabbath School

Please list any special Children's Ministry events you would like to volunteer to help. *

Yes

Spelling Bee

Reading Challenge

Crazy Praize Performance Days

Adventurer Investiture

Vacation Bible School

End of the Year Banquet

Community Service Events

Sports Outings (Field Days, Park Days)

I consent to my child taking part in the approved programs and activities for Children's Ministries of Mt. Sinai SDA Church (Children's Church, Adventurers, Crazy Praize, Lower Division Sabbath School) *

Yes

I consent to my child viewing DVDs rated G or PG. I understand that all material will be previewed by a leader to check suitability. *

Yes

Required

I grant permission for my child to be photographed, videotaped, recorded, etc for use in promotional or educational activities of Children's Ministry on the website or via social media of the church. *

Yes

I authorize the leaders in charge of the various Children's Ministry programs where it is impractical to communicate with me, to arrange for my child to receive such medical or surgical treatment as the leaders may deem necessary at any time during the activities of Mt. Sinai SDA Children’s Church Ministries. *

Yes

I further authorize the use of Ambulance and/or anesthetic by a qualified medical practitioner if in his/her judgement it is necessary. I accept responsibility for payment of all expenses associated with such treatment. *

Yes

I agree that the leaders and those connected with Mt. Sinai SDA Children's Ministry cannot be held responsible for personal injury, loss or theft of property affecting my child. *

Yes

Electronic Signature (in lieu of my regular signature, printing my name below will serve as my signature of authorization for this form.) *

Submit

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