CHILDREN's MINISTRIES

SOLDOTNA CHURCH of GOD

Child's Information

Child's Full Name

Child's Nickname

Date of Birth

School Grade

Gender
Male
Femal

Special Interests and Activities

Medical/Disability Information

Allergies

Medications

Medications to be taken at church / Time to be taken (must have perscription)

Med

Time to be Taken
am pm

Med

Time to be Taken
am pm

Med

Time to be Taken
am pm

Med

Time to be Taken
am pm

Med

Time to be Taken
am pm

Med

Time to be Taken
am pm

Siblings Attending Sunday School/Bible Study

Name

Age
Name

Age
Name

Age
Name

Age
Name

Age
Name

Age

Mom's Information

Name

Website

Address PO Box or Street/Number City
State
Zip

Phone

Home

Work

Cell

Dad's Information

Name

Website

Address (If different) PO Box or street name and number
City

State

Zip

Phone (If different)

Home

Work

Cell

Guardian's Information

Please provide court paperwork to the Church stating guardianship*

Name

Website

Address (If different) PO Box or Street/Nuber City
State
Zip

Phone (If different)

Home

Work

Cell

Emergency Contact Information

In case of emergency, contact the following individuals

First Person

Name

Relationship to Child

Cell Number

Home Number

Second Person

Name

Relationship to Child

Cell Number

Home Number

Second Person

Name

Relationship to Child

Cell Number

Home Number

Photograph Authorization

We like to take pictures of our students for use on the website, on bulletin boards, and in publications. Do you grant Soldotna Church of God permission to publish photos of your child in the above stated arenas?

Yes
No

Authorised Pick-Up

Dad can pick the child up
Yes
No

Mom can pick the child up
Yes
No

First Person

Name

Home Phone

Cell Phone

Relationship to Child

Address

Second Person

Name

Home Phone

Cell Phone

Relationship to Child

Address

Third Person

Name

Home Phone

Cell Phone

Relationship to Child

Address

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