Child Information Form
Child's Name
*
First Name
Last Name
Called by Name
Child's DOB
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent/Guardian Name(s)
*
Preferred Phone Number
*
Format: 000- 000-0000.
Secondary Phone Number
Format: 000-000-0000.
Preferred Email
*
Child's Grade
*
Please Select
TK or younger
Kindergarten
1st
2nd
3rd
4th
5th
My child
*
has permission to leave Sunday School on his/her own to meet me in church
must be picked up by parents (or person of my choice)
The following people are authorized to pick my child up from Sunday School
*
Child's School
*
Volunteer
I am interested in helping with the following
*
Sunday School Teacher
Sunday School Sub
First Church Leader
First Church Sub
Parent Socials
Grade Level Fellowship
Nativity Play
Outreach Projects
Vacation Bible School
Assist in the nursery from time to time
I'm not able to help at this time.
Medical Questionnaire
Is your child presently being treated for an injury, sickness, or taking any medication?
*
Yes
No
If yes, please explain.
*
Does your child have any allergies?
*
Yes
No
If yes, please list.
*
Does your child require a special diet?
*
Yes
No
If yes, please describe.
*
Does your child have any physical or cognitive challenges which would prevent him/her from participating in normal activity?
*
Yes
No
If yes, please explain.
*
Anything else you'd like us to know about your child?
Insurance Information
Medical Insurance Provider Name
*
Medical Insurance Provider's Phone Number
*
Name of Insured
*
Policy #
*
Physician's Name
*
Physician's Phone Number
*
Medical Treatment Authorization
Signature
*
Back
Next
Name of Emergency Contact (if neither parent can be reached)
*
First Name
Last Name
Emergency Contact Phone Number
*
Format: 000-000-0000.
Emergency Contact Relationship to Child
*
Grandparent
Aunt/Uncle
Babysitter/Nanny
Friend/Neighbor
Other
Parent Sunday School Class
*
Chapel Class
Good Samaritan
Passages
Conversations
Friends in Faith
Varies/None
Child's favorite activities/toys?
Please indicate where you typically sit in the Sanctuary using the diagram below.
*
A-Amen Corner
B- Chancel
C- Main Floor Left
D-Main Floor Right
E- Sanctuary Overflow
F- Upper Back Balcony
Submit
Should be Empty: