Children's Ministries Registration
Child's Full Name
Date of Birth 00/00/00Current Grade
Date of Birth 00/00/00Current GradeMother or Guardian's Full Name Mother's Email Address (optional)
Mother's Email Address (optional)Father or Guardian's Full Name Father's Email Address (optional)
Father's Email Address (optional)Mailing Address (PO Box or Street, City, State, Zip)
Home Phone Mother's Cell Father's Cell
Mother's Cell Father's CellEmergency Contact (Name) Emergency Contact Phone
Emergency Contact PhoneWho has legal custody of this child?
Who other than you is authorized to pick up this child?
Allergies or Medical Concerns
Name of Friend Child Would Like to Be With
Other Pertinent Information or Questions
Please submit one child's information at a time.
CHARTER OAK COMMUNITY CHURCH
