Children’s Ministry Registration – New England Bible Church

I am signing my child(ren) up for the following program(s): *

Nursery
Children's Church
Sunday School
Awana

1. Child's Name

Child's date of birth (mm-dd-yyyy) *

Child's grade for 2021-2022 school year: *

Please list any allergies/medications/special needs

2. Child's Name

Child's date of birth (mm-dd-yyyy) *

Child's grade for 2021-2022 school year: *

Please list any allergies/medications/special needs

3. Child's Name

Child's date of birth (mm-dd-yyyy) *

Child's grade for 2021-2022 school year: *

Please list any allergies/medications/special needs

4. Child's Name

Child's date of birth (mm-dd-yyyy) *

Child's grade for 2021-2022 school year: *

Please list any allergies/medications/special needs

Guardian's name *

First

Last

Relationship to child *

Additional guardian's name

First

Last

Relationship to child

Address *

City *

State *

Zip code *

Phone number *

Email *

Additional Email

Emergency contact name *

Emergency contact phone number *

Aside from the guardians listed above, who else is authorized to pick up this child from activities at NEBC? *

Terms & Conditions *

I have read the terms and conditions below.

I understand that my child/children may participate in physical activities during game time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any liability, New England Bible Church and any persons involved in the ministry. I understand that my child/children may eat the provided food at snack time. If my child/children have any food allergies, I have specified them above. In the event of an emergency that requires medical treatment, I understand that every effort will be made to contact me or the designated emergency contact. However, if I/we cannot be reached, I give permission for the volunteers of New England Bible Church to secure the services of a licensed physician to provide the necessary care for my child. I assume all responsibility for all costs connected to any accident or treatment of my child. I give permission to New England Bible Church to take and use photographs, audio, and video in which my child/children appear for use in promotional materials.