Childrens Ministry Registration Form

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Jenny Byxbee, Director of Children's Ministries - jenny@roundhillcommunitychurch.org
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We are:* This field is requiredPlease pick the statement that best describes you.
RHCC Members
Regular Visitors at RHCC
New Visitors to RHCC
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Child 1* This field is required
First Name
Last Name
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Child 1: Birthday* This field is required
Date
Month
Day
Year
Date
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Child 2
First Name
Last Name
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Child 2: Birthday
Date
Month
Day
Year
Date
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Child 3
First Name
Last Name
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Child 3: Birthday
Date
Month
Day
Year
Date
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Child 4
First Name
Last Name
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Child 4: Birthday
Date
Month
Day
Year
Date
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We would like to register for the following programs:* This field is requiredPlease check all those that apply.
Nursery/childcare: birth through age 3
Children's Worship Grades Pre-K & K (must be potty trained)
Children's Worship Grades 1 & 2
Children's Worship Grades 3 & 4
Children's Worship Grade 5
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Primary Parent/Contact * This field is required
First Name
Last Name
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Primary Email Address* This field is required
example@example.com
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Primary Contact: Mobile * This field is required
Area Code
Phone Number
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Primary Contact: Home
Area Code
Phone Number
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Secondary Parent/Contact
First Name
Last Name
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Secondary Email
example@example.com
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Secondary Contact: Mobile
Area Code
Phone Number
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Secondary Contact: Home
Area Code
Phone Number
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List the names of any other adults authorized by you to pick up your child:* This field is required
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It takes a LOT of volunteers to make our program special for our children and families. Parents are asked to donate any time or talents whenever they can. How would you like to volunteer this year?* This field is required
I would like to be contacted when there is a volunteer need.
I would like to teach in Children's Worship. (Classroom curriculum/materials and training are provided.)
I would like to help set up/clean up a big church school activity.
I would like to help with special family events (i.e., Harvest Supper, Advent Workshop, Easter Egg Hunt, Christmas Pageant, Rally Day, Church Picnic, etc.)
I would like to help with the new members welcome committee.
I have certain passions and interests of my own and would like to help in another way. Please contact me to discuss.
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Mailing Address* This field is required
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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We would like our contact information added to the Round Hill Community Church directory.* This field is requiredPlease select an answer below.
YES
NO
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I give my consent to Round Hill Community Church to use photos in which my child may appear on the Round Hill Community Church website and Facebook page, as well as on other social media networks and in printed materials. I understand that no names will be published, used or associated with these photos.* This field is required
YES
NO
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I give my permission for First Aid and/or Emergency Medical Care to be given to my child should I be unable to be contacted in the event of an emergency.* This field is required
YES
NO
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Please be aware of Round Hill Children's Ministry food policy, detailed below:

Several children who attend RHCC have life-threatening food allergies. Others develop uncomfortable reactions to certain food products. For the safety of our children, please respect the food restrictions by using ONLY food provided by the church for church events. Please keep your own food separate from church-provided snacks and be careful to wash your children's hands and face before church events, especially after eating peanut and nut products. Thank you.
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Allergies, special needs or other medical concerns* This field is requiredPlease list symptoms and actions for childcare providers to take.
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Can we share the previously provided medical information with Children's Program volunteers and care providers?* This field is required
YES
NO
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By providing your signature below, you are confirming your full understanding of all the rules, policies and permissions outlined herein, and providing your consent and agreement to all of them. You may use your mouse or touch pad to provide an electronic signature below.
Clear
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Date of E-Signature
Date
Month
Day
Year
Date
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Stay in touch with Round Hill
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Welcome to the Round Hill family!! We look forward to seeing many of you very soon and to another wonderful and productive year together in Children's Worship!
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