Glen Ellyn Bible Church
Children's Ministries Registration
Family Last Name:
*
Date:
*
-
Month
-
Day
Year
Date
Address:
*
Home Phone:
#1 Parent/Guardian Name:
*
Cell Phone:
Email:
#2 Parent/Guardian Name:
Cell Phone:
Email:
#1 Child"s Name:
*
M/F
*
DOB
*
Grade
Allergies/Special Needs:
#2 Child"s Name
M/F
DOB
Grade
Allergies/Special Needs:
#3 Child"s Name:
M/F
DOB
Grade
Allergies/Special Needs:
#4 Child"s Name:
M/F
DOB
Grade
Allergies/Special Needs:
#5 Child"s Name:
M/F
DOB
Grade
Allergies/Special Needs:
I give Glen Ellyn Bible Church and its representatives permission to use photographs or video that include my child in any and all media products for promotion, art, advertising, editorial or other purpose. This may include but is not limited to newsletters both print and email, posters, brochures, ads, post cards and web pages.
*
Yes, I agree to above stated photo release
No, I do not agree to above stated photo release
For Office Use Only
ACS Entry_________ CC directors __________ EM Pastoral_________
Security #____________ Security Cards_________
Nursery: Diaper Bag Tag________ Sign-in_______ Instruction _______ Labels ________
Preschool and Elementary: Labels
Submit
Should be Empty: