MissionKids Registration | Evangelical Covenant Church of Princeton

Child Information

How Many Children Are You Registering?

Child 1 Name

First Last

Current Grade

Allergy or Medical Conditions?

Child 2 Name

First Last

Child 2 Name

First Last

Child 2 Name

First Last

Current Grade

Allergy or Medical Conditions?

Child 3 Name

First Last

Child 3 Name

First Last

Current Grade

Allergy or Medical Conditions?

Child 4 Name

First Last

Current Grade

Allergy or Medical Conditions?

Parent Information

Parent/Guardian Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Parent/Guardian Email Address*

Parent/Guardian Primary Phone Number*

Emergency Contact Name*

First Last

Emergency Contact Phone Number*

Anything Else We Need To Know?

Additional Person Authorized to Pick Up/Check Out Child

First Last

Contact Number for Authorized Person

Alternate pick-up person may be required to provide photo ID if requested.

Permission To Use Photos*

Please indicate your permission for your family members' image to be used as described below by completing this section: In order to protect our children and youth, we use photos and video taped images without names in our print, broadcast, and digital publicity - for example, in the Focus newsletter, on our website, on bulletin boards within the Church building, and in other communications media.

I give permission for my child(ren)'s image to be used without names as described above
I do NOT give permission

Name

This field is for validation purposes and should be left unchanged.