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
Date Format: 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 Information
Name
Best Contact Number
Email*
Father / Guardian Information:
Name
Best Contact Number
Email

Emergency and Medical Information
In case of an emergency contact
Best Contact Number
ALLERGIES / MEDICAL CONDITIONS
Does 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 AGREEMENT
Please 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
*
Date
Date Format: MM slash DD slash YYYY

Thu 20

Sanctuary Choir Rehearsal

June 20 @ 6:00 pm - 7:30 pm

Fri 21

Couples Urban Ballroom Dance lessons

June 21 @ 6:30 pm - 7:30 pm

Sat 22

Sliders Dance Rehearsal

June 22 @ 10:00 am - 11:00 am

Tue 25

Keenagers Mat Making

June 25 @ 10:00 am - 12:00 pm

Tue 25

Progressive Choir Rehearsal

June 25 @ 6:30 pm - 8:00 pm