Children's Registration Form
Please fill out the emergency contact form below for each child involved in CROSSROADS' Childrens Ministry!
First Name
Last Name
Date of Birth
Special Needs
Allergies
School Grade
-- None --
Nursery 1 yr olds
Nursery 2 yr olds
Nursery 3 yr olds
Preschool 4 yr olds
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
In the event I am unable to pick up this child, I allow CROSSROADS CHURCH to release this child into the care of the following people:
Parent/Guardian #1
First Name
*
Last Name
*
Preferred Name
Email Address
*
Mobile Number
*
Home Address
*
Home Address Line 2
Home City
*
Home Zip Code
*
Home State
*
Parent/Guardian #2
First Name
*
Last Name
*
Preferred Name
Phone Number
*
Email Address
*
Address
*
Address Line 2
City
*
State
*
Zip Code
*
Expected Attendance
What service(s) do you expect to attend?
*
Lakeville 9:30am Sun. 5:30pm Wed.
Inver Grove Heights 10:30am Sun. 5:30pm Wed.
Photo/Video Release
Do you give permission for photographs of our child(ren) to be used for CROSSROADS website and publications?
*
Yes
No
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