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First Calvary Baptist Church
Registration for Children Church Participants Form
Page 1
page 1 of 3
Name *
required
First Name
Last Name
Email *
required
Email Address
Relationship to Child
select one
Select one
Mother
Father
Grandparent
Other
Parent (2) Information
Parent(s) Name
required
First Name
Last Name
Parent Email Address:
required
Email Address
Parent Cell
required
Phone Number
Relationship to Child:
select one
Select one
Mother
Father
Grandparent
Other
Child (1) Name
Name
required
First Name
Last Name
Age of Child *
required
Child's Date of Birth (mm/dd/year) *
required
Click in box to select date
Child's Current Grade *
select one
Select one
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
School
required
Has the child been baptized?
select one
Select one
Yes
No
Allergies?
required
Things I would like you to know about my child (behavorial issues, medical issues, spiritual issues)
required
Page 1
page 2 of 3
Child (2) Name
Name
required
First Name
Last Name
Age of Child
required
Child's Date of Birth (mm/dd/year)
required
Click in box to select date
Child's Current Grade
select one
Select one
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
School
required
Has the child been baptized?
select one
Select from list
Yes
No
Allergies?
required
Things I would like you to know about my child (behavorial issues, medical issues, spiritual issues)
required
Page 2
page 3 of 3
Name
required
First Name
Last Name
Age of Child
required
Child's Date of Birth (mm/dd/year)
required
Click in box to select date
Child's Current Grade
select one
Select one
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
School
required
Has the child been baptized?
select one
Select one
Yes
No
Allergies?
required
Things I would like you to know about my child (behavorial issues, medical issues, spiritual issues)
required
Additional Information
In Case of emergencies, what is the best number to contact you with?
required
Names of people you have authorized to pick up your child (other than yourself)
required
Signature
By signing this Electronic Signature, I agree that my electronic signature is the legally binding equivalent to my handwritten signature.
Type Name Below *
required
Today's Date (mm/dd/year)
required
Click in box to select date
* required
