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

Fri 24

Urban Ballroom Lessons

January 24 @ 6:30 pm - 7:30 pm

Sat 25

Sliders Dance Rehearsal

January 25 @ 10:00 am - 11:00 am

Sun 26

S.E.E.K. Young Adult Ministry Launch

January 26 @ 10:00 am - 3:00 pm

Mon 27

Winter Revival

January 27 @ 7:00 pm - 9:00 pm

Tue 28

Keenagers Mat Making

January 28 @ 10:00 am - 12:00 pm