Please take a moment to complete the registration information for your child.  We want to be sure we have current parent/guardian contact information and allergy information for all children attending our programs and events. Please complete one form per child.

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Child's Name *

First

Last

Name Child Goes By (optional)

Date of Birth *

My Child will be Attending (choose one) *

• The Nursery During Worship Service (infant – preschool)
• Children Worship & Wonder During Worship Service (K – 5th grade)
• Youth Group (6th – 12th grade)

Child Primary Address

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

High School Graduation Year

Allergies / Medical Information *

Please list (describe as necessary) any allergies or medical issues of which supervising adults should be aware. (If none, indicate by typing n/a).

Parent or Guardian #1 *

First

Last

Phone Number (Parent / Guardian #1) *

Email *

Preferred Method of Contact (Parent / Guardian #1) *

• Phone call
• Text
• Email

Parent or Guardian #2

First

Last

Phone Number (Parent / Guardian #2)

Email

Preferred Method of Contact (Parent / Guardian #2)

• Phone call
• Text
• Email

Photo Consent Opt-Out

• Do NOT use my child’s photo

If we have your consent to use photos of the child listed above, leave the box unchecked. By not checking the box you are indicating your consent for using photos of the child listed above in the SFCC website, social media and print materials.

Signature *

Type your name in the above field to serve as your signature. By signing this form, I agree to the terms and conditions of the Liability Release Waiver and First Aid and Emergency Medical Treatment Waivers linked to below.

Submit

I (Parent or Guardian First & Last Name) represent that I am the parent/guardian of the child listed above, who is under 18 years of age. I have read the above Permission/Waiver Form and am fully familiar with the contents thereof. I give permission for the child named above to participate in the activities of Smithville First Christian Church, including any special events/activities described above. In consideration for allowing the participation of the child in the activities of Smithville First Christian Church, I hereby consent to the Permission/Waiver Form, including the Release of Liability and First Aid and Emergency Medical Treatment, on behalf of the child, and agree that this Permission/Waiver Form shall be binding upon me, my family, heirs, legal representatives, successors, and assigns.