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*
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*
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*
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*
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*
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*
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*
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.
