Children's Ministry Registration

How many children are you registering?
If you have more than 3 children, please fill out a separate form for them.
- 1
- 2
- 3
Child #1
Name of child
As printed on name tag
First Last
Birthdate
Date Format: MM slash DD slash YYYY
Gender
2018-2019 Grade
Child's School (if applicable)
Child #2
Name of child
As printed on name tag
First Last
Birthdate
Date Format: MM slash DD slash YYYY
Gender
2018-2019 Grade
Child's School (if applicable)
Child #3
Name of child
As printed on name tag
First Last
Birthdate
Date Format: MM slash DD slash YYYY
Gender
2018-2019 Grade
Child's School (if applicable)
Family Information
Parent Name
First Last
Parent Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone Number
Other Phone Number
Emergency Contact Name and Relationship
Emergency Phone
Other Information (allergies or other special conditions)
Release and Consent
I understand that activities and programs may be photographed and/or videotaped. I agree to release Cypress Lake UMC from any and all liabilities in connection with photographing my child(ren) and including them in any form of advertisement. This includes website, web pages, brochures, videos, ads, and billboards but is not exclusive to this list of items. I understand that my child's name will not be used in conjunction with his/her picture.
Name
Please enter your first and last name to signify you have read and agree to the above consent form.
First Last
Email Updates
Would you like to receive email updates on the Children's Ministry and programs for families?
- Add my name to the email list, or keep it on if already there.
- Please remove my name from the email list.

Child #1

Child #2

Child #3

Family Information

Release and Consent

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