Children's Ministry Registration

Name

Gender

Male Female

Address

Date Of Birth

Health Card # / Version Code

Health Card Exp

Parent/Guardian #1

Relation to Child Father Mother Guardian

Address

Phone

This address will receive a confirmation email

Parent/Guardian #2

Relation to Child

Father Mother Guardian

Address

Phone

This address will receive a confirmation email

Child Lives With Father Mother Guardian

Allergies / Medical Concerns / Special Needs

I give permission for the child named above to participate in the events at Kingston Gospel Temple. I give permission for the staff and volunteers of Kingston Gospel Temple to seek medical attention in the case of emergencies.

Yes No

I give permission for the child named above to appear in images or video online or in printed promotional material as deemed acceptable by the staff and volunteers of Kingston Gospel Temple.

Yes No

none">Kingston Gospel Temple is collecting this personal information for the purpose of enrolling your child in our programs, to develop and nurture ongoing relationships with you and your child, and to inform you of program updates and upcoming opportunities at our church. This information will be maintained permanently as it is a requirement of our insurance company and legal counsel. If you wish Kingston Gospel Temple to limit the information collected, or to view your student’s information, please contact us.

Children's Ministry Registration

Description

Please Fix the Following