Youth Group, Church School & Nursery Registration 2023 - 2024

Family Information

Parent 1 Full Name

Parent 1 Would You Like To Volunteer

Parent 2 Full Name

Parent 2 Would You Like To Volunteer

Home Address

Best Contact Phone Number

Alternate Phone Number

Family Email Address

This address will receive a confirmation email

Alternative Pickup Information

Please list alternative pickup persons or family names of those authorized to pick up your child(ren) singly per line, if applicable. If you do not have any information for this section, please skip to the Child Information section!

Alternative Pickup Person(s) & Family Names

Child 1 Information

There are multiple sections of child information, please complete only those needed and skip over the extras!

Child's Name

Which Program Would You Like To Enroll Your Child In?

Child's Date of Birth

Current Age

Any Allergies?

Child 2 Information

Child's Name

What Program Would You Like To Enroll Your Child In?

Child's Date of Birth

Current Age

Any Allergies?

Child 3 Information

Child's Name

What Program Would You Like To Enroll Your Child In?

Child's Date of Birth

Current Age

Any Allergies?

Child 4 Information

Child's Name

What Program Would You Like To Enroll Your Child In?

Child's Date of Birth

Current Age

Any Allergies?

Photography Release Statements

Within The Church: I give permission for staff and volunteers to take photographs of my child(ren) during church events, and to use them in the church building for publicity, classroom decorations, and on bulletin boards. Please choose I Consent or I Do Not Consent

Outside The Church: I give permission for photographs of my child(ren) to be used for church publicity in publications and online. I understand that children are never identified by name, unless given explicit permission to do so. Please choose I Consent or I Do Not Consent

Authentication

Please type your name in the box below. This is considered your digital signature.

Description

Please complete (1) one of these forms per family. This information may be shared with teachers and other volunteers in our Church School, Youth Group and Nursery programs at The Rehoboth Congregational Church. For safety reasons, we require this form to be completed for all children and youth each school year.

Once you have completed this form, please click submit.

Youth Group, Church School & Nursery Registration 2023 - 2024

Description

Please Fix the Following