SVNC KIDS MINISTRY REGISTRATION FORM

For children ages birth through 5th grade

Your name *

Email address *

Legal Guardian/Parent(s) Names

Address

Phone Numbers

Please list for all guardians/parents and indicate who the number belongs to and whether it is a home, work or cell phone.

Child (1) Name

Birthdate

Grade

Please list any allergies we should be aware of for Child (1):

Child (2) Name

Birthdate

Grade

Please list any allergies we should be aware of for Child (2):

Child (3) Name

Birthdate

Grade

Please list any allergies we should be aware of for Child (3):

Child (4) Name

Birthdate

Grade

Please list any allergies we should be aware of for Child (4):

Please list ALL adults who are authorized to pick up your child(ren) *

Location of Guardian/Parent while child is checked in to Kids Ministry

Please note: Guardian/Parent must remain on campus if child is checked in to the nursery

Permissions

I hereby give the following selected permissions for my child(ren)'s photo and/or video to be used in:

Children's Ministry Family *

Communications between parents and families involved in the SVNC Children's Ministry or displaying photos/videos on our in-house media. Please note--we will never list the names of any children.

Yes

Communications on the church Facebook page *

Spokane Valley Church of the Nazarene, including posting pictures and or video for the purposes of informing church attendees of activities. Please note--we will never list the names of any children.

Yes

Promotional media *

For the purpose of promoting SVNC Sunday Classes and KidsQuest in print, video, or on our website. Please note--we will never list the names of any children.

Yes

Are you interested in volunteering in our Children's Ministry? *

Whether is it helping check-in kids, subbing when a teacher is gone, volunteering on a regular basis or helping out once in a while, we could really use your help any way we can get it! Please indicate below if you are interested in volunteering or finding out more. Thank you!

Other comments or special instructions

Signature: LEGAL GUARDIAN/PARENT PRINT NAME BELOW to sign *

Date signed