Kids Ministry Registration Child's Name * First Name Last Name Birthdate * MM DD YYYY Age * < 1 Year 1 2 3 4 5 6 7 8 9 10 11 12 Grade * Nursery Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Parent/Guardian Names * Family Email * Do you give permission for screened leaders of our ministry program to contact your child/family by email as a way of building appropriate friendships? * Sure! No thanks! Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country School Attending: Additional Comments Are there particular needs, special interests that your child would have that you would like their leader to be aware of? I give permission for Emmanuel Baptist Church to use photos of my child from church events. * For internal use only For both internal and external use Do not use my child's picture Does your child have any needs we should be aware of (medical, allergies, accommodations)? In case of emergency, if I can't be reached, please contact: * (###) ### #### Release of Liability * In case of an emergency, I understand that every reasonable effort will be made to contact me. In the event that I cannot be contacted, I hereby give permission to the attending physician to provide medical treatment. I understand that every precaution will be taken for the safety and good health of my child, but in the event of accident or sickness, I hereby release Emmanuel Baptist Church, its staff and volunteers from any liability. I agree Thank you so much!
