Child's Personal Information
Full Name
Gender
Choose One
Male
Female
Birthdate (MDY)
Address
City
Province
Alberta (AB)
British Columbia (BC)
Manitoba (MB)
New Brunswick (NB)
Newfoundland and Labrador (NL)
Northwest Territories (NT)
Nova Scotia (NS)
Nunavut (NU)
Prince Edward Island (PE)
Saskatchewan (SK)
Ontario (ON)
Quebec (QC)
Yukon (YT)
Postal Code
Phone Number
Age
Grade
List any and all allergies
List any and all special needs
Father's Information
Full Name
Address (if different than childs')
Phone Number (if different than child's)
Cell Phone
Mothers Information
Full Name
Address (if different than childs')
Phone Number (if different than child's)
Cell Phone
Photographic Permission
I hereby grant permission to the leaders and teachers in the Children's Ministry of White Rock Community Church to photograph and/or videotape my child for occasional classroom and general use.
I agree
(By clicking this checkbox you have agreed and accepted the above statement).
Parent/Guardian Name
