Page 46 | Covenant Christian Church HB

Please fill out this form for each child that will be in Nursery or Children's Church.

Child's Last Name (Required)

Child's First Name (Required)

Preferred Name

Child's Birth Date (Required)

Child's Current Grade in School? (If Applicable)

Preschool through 6th Grade

Gender (Required)

Address (Required)

Parent's Names (Required)

Parent's Email Address (Required)

Phone Number (Required)

Emergency Contact (Required)

In the event of an emergency, who do we contact? Phone number?

Medical Conditions/Allergies/Special Needs

Can anyone else pick up your child besides the person who dropped them off? (Required)

If YES, who?

Is your child potty trained? (Required)

Any other helpful information you want us to know

Solve 9 + 1 = ?

Covenant Christian Church HB