Child's Name

First Name

Last Name

Name child goes by

Your Name

First Name

Last Name

Your Email

Child's Birthday

YYYY

Child's gender

Male

Female

Can your child have a snack with the class?

Yes

Allergies or Medical Conditions

Child's favorite activities..

Child does NOT like..

Has your child ever been left in children's church/nursery before?

Yes

Does your child have any special words or things we should know? (Example: Pacifier-sisis)

Only these additional people are allowed to pick up my child from children's church/nursery:

Is there anything you would like us to know about your child?

I give permission to take my child's picture for church website/social media:

Yes

By submitting this form, you are verifying that you are the parent/guardian and all information is accurate and correct to your knowledge

Yes, I agree