COR Child and Youth Registration Form

Parent/Guardian 1 Info

Name

Pronouns

she/her he/him they/them Other

This address will receive a confirmation email

Phone

May we text this phone number with Family Ministry information?

Yes No

Address

Parent/Guardian 2 (Optional)

First and last name

Phone

May we text this number with Family Ministry information? Yes No

Emergency Contact Information

Please list the name of a trusted friend or family member whom we may contact in case of an emergency when parent/guardian cannot be reached.

Emergency contact name

Emergency contact number

Child/Youth 1 Information

First and last name

Date of Birth

Please tell us about any health concerns, dietary restrictions, allergies, or any other special needs for your child.

Health and medical notes

Child/Youth 2 Information

First and last name

Date of birth

Please tell us about any health concerns, dietary restrictions, allergies, or any other special needs for your child.

Health and medical notes

Child/Youth 3 Information

First and last name

Date of birth

Please tell us about any health concerns, dietary restrictions, allergies, or any other special needs for your child.

Health and medical notes

Child/Youth 4 Information

First and last name

Date of birth

Please tell us about any health concerns, dietary restrictions, allergies, or any other special needs for your child.

From time to time photographs and/or videography may be made of your child for publication in the church newsletter or on the church website for promotional purposes. Children’s names will not be published without permission. Please indicate here whether you agree to have your child photographed.

Yes, I agree to have my child’s photograph to be taken/published No, I do not want my child’s photograph to be taken/published

COR Child and Youth Registration Form

Description

Please Fix the Following