Children’s Ministry Registration Form

Parent/ Legal Guardian Name *

First

Last

Relationship to Child(ren) *

Full Mailing Address *

Preferred Phone Number *

Email *

In the event of an emergency, I authorize first aid or medical treatment for each child named below, and I release Jackson Friends Church from any and all responsibility in connection therewith. *

By checking this box, I agree to the statement above.

Child #1 *

First

Last

Child #1 Birthday *

Child #1 Grade *

Child #1 Special Instructions/Allergies

Child #2

First

Last

Child #2 Birthday

Child #2 Grade

Child #2 Special Instructions/Allergies

Child #3

First

Last

Child #3 Birthday

Child #3 Grade

Child #3 Special Instructions/Allergies

Child #4

First

Last

Child #4 Birthday

Child #4 Grade

Child #4 Special Instructions/Allergies

Child #5

First

Last

Child #5 Birthday

Child #5 Grade

Child #5 Special Instructions/Allergies