Fillable Church Registration Form (Page 2 of 3) in pdf

Church Registration Form Page 2

Download a blank fillable Church Registration Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Church Registration Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Your child will only be released to an authorized person listed on this form (parent/

guardian and/or emergency contact). In case of an emergency or an unforeseen

circumstance, please indicate the name, address and phone number of any other

person/s who you authorize to pickup your child on your behalf.

Name

Address

Phone

A parent/guardian's verbal authorization for pickup must be received before your child

will be released to anyone not listed here. If not received, and we cannot notify you by

phone, the child will not be released.

MEDICAL INFORMATION

Doctor

Office Phone

Address

City:

Zip Code

Medical Ins. #

Child's Personal ID#:

Allergies:

Medical Problems:

Medication:

ADDITIONAL INFORMATION: Please indicate likes/dislikes, potty training, special

interests, etc.

IMMUNIZATION:

The Health Unit now requires that we have a photocopy of your child's

recent immunization record in our files. Please include a photocopy with this registration

form. If you do not have the records, a copy can be obtained from your local health

unit.

Note: If submitting electronically, please provide immunization records

to the church directly or by email to Sandra Francois along with this registration form.

Church Registration Form Page 2

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