Child Info Form

Please provide information about your child. We only use this information for church related activities & events or to contact you while your child is with us.

Your name *

Email address *

Address

Phone number *

Child's Name (option to enter more children below) *

Birthdate *

Gender

School Name

Current Grade (Children's Ministry is 6 weeks-5th Grade)

Staci Hissong, Children's Ministry Director

Current Grade (Student Ministry is 6th-12th Grade)

Kim Johnson, Student Ministry Director

Food Allergies? *

yes

Household members

Custody Issues we need to be aware of? This info is PRIVATE & used for safety & dismissal purposes only.

yes

Any other information we need to know about you or your child(ren)? (medical, behavioral, etc.)

Additional Adults who are allowed to pick-up your child:

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