Church Registration Form For Kids
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1Today’s Date
Last Name:
: ______________
Zion Kids
Registration Use Only
Registration Form
PLEASE PRINT ALL INFORMATION AND FILL OUT FORM IN ITS ENTIRETY
It is our desire to minister to your child with excellence.
Please provide us with the following information.
Child’s Address
_________________________________________
:
(Number & Street)
1. Child’s Full Name:
Date of Birth:
Age & Grade:
_________________________________________
Male/
(City, St)
(Zip)
Female
Child Lives With
________________________________________
:
Allergies or Health Concerns/ Special Needs:
Is there a custody issue that we should be aware of? : Yes / No
If yes, please fill out custody form.
2. Child’s Full Name:
Date of Birth:
Age & Grade:
Male/
Female
Father’s Name: _________________________________________
(or Legal Guardian)
(First)
(Last)
Allergies or Health Concerns/ Special Needs:
Mother’s Name
: _________________________________________________
(or Legal Guardian)
(First)
(Last)
3. Child’s Full Name:
Date of Birth:
Age & Grade:
Male/
Contact Cell Phone Number (please set for silent during service)
:
Female
__________ - ___________ - _______________________________
Allergies or Health Concerns/ Special Needs:
Family Email
: ___________________________________________________
4. Child’s Full Name:
Date of Birth:
Age & Grade:
Home Phone: ____________ -___________-___________________
Male/
Female
How did you hear about Zion? (friend, internet, etc.)
Allergies or Health Concerns/ Special Needs:
______________________________________________________
If not parent or legal guardian, please fill out the following:
For Registration Worker Use Only:
For Office Use Only:
o
Added to ACS w/ Call Out Numbers
Child came to church with
: ______________________________________
Processing Worker’s Initials __________
on __________ by __________
Full Name of Adult
Relationship to child
: ___________________________________________
o
Letter Sent on __________ by __________
Diaper Form
Yes: Diaper/Potty
Cell Phone
-___________-_____________________
:
____________
o
Phone Call on __________ by __________
No: Diaper/Potty
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