Neelsville Children's Classes Registration
A separate registration is required for each child. Please complete this form for all children in your household who are eligible for Children's Programs and/or Worship & Play Zone care. Middle school and high school students have a separate registration form.
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Email *
Mailing Address *
Parent/Guardian Name *
Parent/Guardian Phone Number *
Can this number receive text messages? *
2nd Parent/Guardian Name *
2nd Parent/Guardian Phone Number *
Can this number receive text messages? *
Emergency contact if parent/guardian cannot be reached. (full name, contact number, relationship) *
Child's First & Last Name *
Child's Birthday (mm/dd/yy) *
Child's grade level as of September 2021 *
Name of child's school (if currently attending one). If none, type none. *
Allergies *
Please state "None" or the specific allergies your child has. If your child has a prescription for emergency medication, please indicate that below. Our Children's Ministry Director Melissa will be in touch to discuss a plan.
Other Medical Concerns *
Please state "none" if your child does not have any medical concerns to be noted by our Sunday School teachers and staff.
Please list anything else that would be helpful for us to know about your child. *
This could include any needs your child may have that would help us best minister to him or her.  You can write "none."
Parents/guardians are required to  be on campus during in-person events, such as Sunday School and Worship & Play Zone. *
Required
Children must be 24 hours symptom free (without medication) in order to attend. If my child has a fever of 100 degrees or higher or other symptoms of illness including: vomiting, excessive coughing, runny nose, head lice, conjunctivitis (eye infection), unexplained rash, etc. I will keep them home. *
Required
My child will only be released to myself, the other parent/guardian on this form, or those adults that I authorize in advance. *
Required
I agree to my child's photos being used in newsletters, promotional tools like brochures, social media, or other uses deemed appropriate by Neelsville Presbyterian Church. *
I give permission for Neelsville volunteers to call emergency personnel and give appropriate treatment for my child in the event I cannot be reached during a medical emergency. I understand that I, the parent or guardian, have financial responsibility and liability for my child's illnesses or injury incurred on site at Neelsville Church. *
Please type the full name of the person who has completed this online registration form and date as your electronic signature. By doing so, you confirm that all of the information you have provided and agreed to is true. *
First name      Last name       Date
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