Childrens Registration Form for Awana and Childrens Church

Enter Child's Name (Lastname, Firstname) ("Nickname"):

Child's Date of Birth :

Gender of Child:

School child attends and what Grade:

Address of Child:

Enter Father's or legal Guardian's Name (Lastname, Firstname):

Enter Mother's Name (Lastname, Firstname):

Phone number for us to contact you during the services, or in case of an emergency (You can list more than one. ie xxx-xxx-xxxx, yyy-yyy-yyyy

Email address that you wish to share to get information about your child's activites:

Enter alternate people allowed to pick up your child and their phone numbers if known:

Enter Allergies or anything else we should know about your child (i.e.; Medical Condition):

Are snacks ok.?

Preferred way of us contacting you (Mark below)

Text

Phone

I understand that my child/ren may participate in physical activities such as those during game time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, Shippensburg First Church of God and any person involved in the Ignite Children's Ministry.

I Agree to above paragraph.

I Do Not Agree

In the event of emergecy that requires medical treatment for the above named child/ren, I understand every effort will be made to contact me or my emergency contact . However, if I/We cannot be reached, I give permission to the Ignite Volunteers to secure the services of a licensed physician to provide the care necessary for my child's well being. I assume responsibility for all costs connected to any accident.

I Agree to above paragraph.

I Do Not Agree

I hereby grant permission to Shippensburg First Church of God to use my Child/ren's photograph(s) on its Website, Facebook or in other official church printed publications without further consideration. I acknowledge the church has the right to crop or treat the photograph(s) at its discretion. I also understand that once my image is posted on the church’s website, the image can be downloaded by any computer user, anywhere in the world. Therefore, I agree to indemnify and hold harmless the church, its trustees, pastor, associate pastors, deacons, its members and designees from any claims arising out of the use of my photograph(s). The church reserves the right to discontinue use of any photograph(s) without notice.

I Agree to above paragraph.

I Do Not Agree

I have read and understand the terms and conditions above

For any questions, please email...ChildrensMinistries@ShipFCOG.org

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