Eastside Children's Ministry Registration | Eastside Church

Complete this form to register your children to attend Eastside Children's Ministry.

This form can accommodate up to four children.

Eastside Children's Ministry Registration

Parent/Guardian Name*

Parent/Guardian Address*

Parent/Guardian Phone*( ) -

Emergency Phone Number( ) -

optional - for use during Church activities if different from number above

Name of emergency contact

if different from above

Parent/Guardian Email*

FIRST CHILD

First Child Name*

First Child Date of Birth*

First Child Current Age*

First Child School Grade*

current or upcoming school year

First Child Food Allergies

Peanuts

Tree Nuts

Gluten

check all that apply

First Child Other Allergies or Health Concerns

list any that apply or special considerations

SECOND CHILD

Second Child Name

Second Child Date of Birth

Second Child Current Age

Second Child School Grade

current or upcoming school year

Second Child Food Allergies

Peanuts

Tree Nuts

Gluten

check all that apply

Second Child Other Allergies or Health Concerns

THIRD CHILD

Third Child Name

Third Child Date of Birth

Third Child Current Age

Third Child School Grade

current or upcoming school year

Third Child Food Allergies

Peanuts

Tree Nuts

Gluten

check all that apply

Third Child Other Allergies or Health Concerns

FOURTH CHILD

Fourth Child Name

Fourth Child Date of Birth

Fourth Child Current Age

Fourth Child School Grade

current or upcoming school year

Fourth Child Food Allergies

Peanuts

Tree Nuts

Gluten

check all that apply

Fourth Child Other Allergies or Health Concerns

Media Release Permission*

I grant permission for Eastside Church to use my child's/children's photograph (without revealing their name(s)) in Eastside Church publications, including the church website and/or in emailed newsletters.

I do not give permission for Eastside Church to use my child's/children's photograph (without revealing their name(s)) in Eastside Church publications, including the church website and/or in emailed newsletter.

Registration Verification*

By checking this box, I acknowledge that this serves as my electronic signature for the above registration and media release

Please leave this field blank.

Location

Contact

Complete this form to register your children to attend Eastside Children's Ministry.