West Edmonton Baptist Church Kidz Ministry (WEB Kidz) Registration 2021-2022: Child Information Form

Please fill out the form below, one form for each participant, then press "Submit." Please ensure that you have also completed the additional form, Consent to Participate in WEB Children's Ministries: 2021-2022. Both forms are required in order for your child to participate in WEB Children's Ministries.

Child Information

Please register child in:

Nursery Kidz Church

Name

Address

Grade

Birthdate

Gender

Male Female

Church Affiliation

If other church, please specify:

Health and Safety Information: Please list any health concerns, medications, allergies, or other information you would like us to know about your child below.

Health Information

For safety reasons, parents/guardians are required to sign out their children. If you wish to waive this requirement, please check

Yes No

Parent/Guardian 1 Information (Required)

Parent/Guardian 1 Name

Parent/Guardian 1 Relationship

Parent/Guardian 1 Cell

Parent/Guardian 1 Email

Parent/Guardian 1 Address, if different:

Custody Details
If parents do not reside together, who has legal custody of the children? (shared, sole custody, etc). Please detail in the field below.

Custody Details

Parent/Guardian 2 Information

Parent/Guardian 2 Name

Parent/Guardian 2 Relationship

Parent/Guardian 2 Cell

Parent/Guardian 2 Email

Parent/Guardian 2 Address, if different:

Emergency Contact - must be different from parents/guardians.

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Cell

Please list any other people besides the legal parent(s)/guardian(s) who are allowed to bring/pick up your child from West Edmonton Baptist Church.

West Edmonton Baptist Church Kidz Ministry (WEB Kidz) Registration 2021-2022: Child Information Form

Description

Please Fix the Following