KIDS MINISTRY PROGRAMMING REGISTRATION FORM

Please complete this form if your child will be attending kids' programming or childcare without you staying with them.

Today's Date

Child's First Name

Child's Last Name

Child's Birthdate

Gender

Grade (if applicable)

Allergies

Parent/Guardian First Name

Parent/Guardian Last Name

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Primary Email

Cell Phone Number

PLEASE CHECK ALL BOXES THAT APPLY

I do not want West Lawn taking pictures of my child to be used in their "in-house" or social media promotional materials.

I do not want West Lawn Nursery Staff to change my child's diaper.

I do not want to receive communications regarding Kids' Ministry program offerings, announcements, or reminders.

I give the following people permission to pick my child up from programming (please list person's name, #, and relationship).