Childrens Ministry Registration Form

Register Your Child(ren) for Childrens Ministry

Parent/Guardian Info:

* Indicates required field

Parent/Guardian's Name *

First

Last

Phone *

Email *

Address *

Second Parent/Guardian's Name and Cell Phone Number (optional) *

Emergency Contact Name & Cell phone number *

Children Info:
Child 1:

Child 1 - Full Name *

Child 1 - Date of birth *

Child 1 - Grade in School *

Child 2 (optional):

Child 2 - Full Name *

Child 2 - Date of birth *

Child 2 - Grade in School *

Child 3 (optional):

Child 3 - Full Name *

Child 3 - Date of birth *

Child 3 - Grade in School *

*Please share any allergies, medical conditions, learning differences, or other information that would help us provide the best possible experience for your child(ren). All information will be kept confidential. If there is nothing to share, please enter "N/A". *

I give my permission for the above-named child(ren) to participate in Covenant Church of Easton's Children's Ministry programs. I understand that all precautions will be taken to ensure the safety of the children. I agree to hold harmless the Covenant Church of Easton or its agents for any and all claims for injuries, illness, cause of action, the rendering of emergency care, or liability related to participation in Children's Ministry events. In the event that I or an emergency contact cannot be reached in an emergency and my child requires treatment, I hereby authorize the physician selected by the church staff to provide or arrange for appropriate medical care and treatment for my child. I agree that neither I nor my children will attend or participate if we knowingly are experiencing any symptoms of illness or infection, with or without fever. Photographs of children participating in our program may be taken and may appear in brochures, the church e-newsletter, church website or other publicity material. Your permission for photographs including your child is part of the agreement.

I agree to the above *

Agree

Electronic Signature

By entering your name below, you authorize and grant permission for the church leaders to secure necessary medical treatment in the event of an emergency.

Name *

Date *