Children’s Church Registration Please complete one form, PER CHILD. Contact: lwatkins@sixthavebaptist.org Step 1 of 4 25% Child's Full Name Age / Gender / Grade Date of Birth MM slash DD slash YYYY Address Street Address City ZIP Code Has your child been baptized? Yes No Is your child a member of Sixth Avenue Baptist Church? Yes No Mother / Guardian InformationName Best Contact NumberEmail* Father / Guardian Information:Name Best Contact NumberEmail Emergency and Medical InformationIn case of an emergency contact Best Contact NumberALLERGIES / MEDICAL CONDITIONSDoes your child have any allergies or medical condition(s) that we should be aware of? (Please be advised that we are not allowed to dispense medications):Please list any current / historical allergies OR medical conditions PHOTO RELEASE AGREEMENTPlease CHECK one statement below: I authorize Sixth Avenue Baptist Church to use my child’s photo or likeness on the church’s website , printed publications and/or video I DO NOT authorize Sixth Avenue Baptist Church to use my child’s photo or likeness on the church’s website printed publications and/or video. Parents/Guardian Signature.PRINTED NAME * Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY
