Parent/Guardian(s) Name(s)
First
Last
Address*
Primary Phone*
Alternate Phone
Email*
Are both parents living at home?* Yes No
If No, who has legal custody of the child?
If the person who regularly brings the child to church is different than above, please list:
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age* Grade Entering Fall 2019:* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Emergency Contact Name*
First
Last
Emergency Contact Relationship to Child*
Emergency Contact Phone*
Parent(s) typical location during church time or other ministry:*
Family Doctor
Doctor Phone
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe*
My child will attend Sunday School (Infants - Grade 5)* No Yes
My child will attend Sunday Night Service Childcare (Infants - Grade 2)* No Yes
My child will attend Children’s Chorus (Grades 1-5)* Yes No
My child will attend Awana (Age 2 - Grade 5)* Yes No
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2019/2020 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register A 2nd Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child will attend Sunday School (Infants - Grade 5)* Yes No
My child will attend Sunday Night Service Childcare (Infants - Grade 2)* Yes No
My child will attend Children’s Chorus (Grades 1-5)* Yes No
My child will attend Awana (Age 2 - Grade 5)* Yes No
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2019/2020 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 3rd Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child will attend Sunday School (Infants - Grade 5)* Yes No
My child will attend Sunday Night Service Childcare (Infants - Grade 2)* Yes No
My child will attend Children’s Chorus (Grades 1-5)* Yes No
My child will attend Awana (Age 2 - Grade 5)* Yes No
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2019/2020 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 4th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child will attend Sunday School (Infants - Grade 5)* Yes No
My child will attend Sunday Night Service Childcare (Infants - Grade 2)* Yes No
My child will attend Children’s Chorus (Grades 1-5)* Yes No
My child will attend Awana (Age 2 - Grade 5)* Yes No
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2019/2020 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 5th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child will attend Sunday School (Infants - Grade 5)* Yes No
My child will attend Sunday Night Service Childcare (Infants - Grade 2)* Yes No
My child will attend Children’s Chorus (Grades 1-5)* Yes No
My child will attend Awana (Age 2 - Grade 5)* Yes No
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2019/2020 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 6th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child will attend Sunday School (Infants - Grade 5)* Yes No
My child will attend Sunday Night Service Childcare (Infants - Grade 2)* Yes No
My child will attend Children’s Chorus (Grades 1-5)* Yes No
My child will attend Awana (Age 2 - Grade 5)* Yes No
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2019/2020 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
Would You Like To Register a 7th Child?* No Yes
Child Name*
First
Last
Gender* Child Birthday*
Date Format: MM slash DD slash YYYY
Age*
Grade* Early Childhood Preschool Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
My child has medical concerns that the church should be aware of.* Yes No
If Yes, please describe
My child will attend Sunday School (Infants - Grade 5)* Yes No
My child will attend Sunday Night Service Childcare (Infants - Grade 2)* Yes No
My child will attend Children’s Chorus (Grades 1-5)* Yes No
My child will attend Awana (Age 2 - Grade 5)* Yes No
My child is physically fit and adequately trained to participate in such programs or events, except (please specify all exceptions)*
In what community will you be while your child is participating in our weekly programming?*
Release and Medical Authorization* Consent and Release
I am the parent/legal guardian of the above named child and have the authority to consent to the participation of this child in The Moody Church Children’s Ministry. I consent to the participation of my child in the functions, programs, and activities of that Ministry during the 2019/2020 program year (September through August), including any and all programs and activities customarily associated with a church children’s group.
I also consent to my child riding in a vehicle driving by a Moody Church pastor, staff member, volunteer, or hired commercial driver.
I agree that The Moody Church, its Board members, employees, agents, and volunteers shall not be liable for damages, losses, diseases, injuries, or death while attending or participating in a program, function, or activity of The Moody Church Children’s Ministries or while traveling to and from any such program, function, or activity. I hereby release and waive any claims which I or my child may have or hereafter acquire against The Moody Church, its Board members, employees, agents, or volunteers for any such damages, losses, diseases, injuries, or death.
Publicity Consent
I allow my child’s picture to be used by the Children’s & Youth Ministries for various needs such as newsletters and/or The Moody Church website.
