NR Children's Information Card Web pdf

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guest information & enrollment Today’s Date:

Service Hour:

9:00

Child’s Full Name:

Date of Birth:

Food Allergies or Special Needs:

Age:

Crawling

Walking

2

Grade

Date of Birth:

Food Allergies or Special Needs:

Age:

Crawling

Parent(s)/Guardian(s): Street Address: City, State, Zip: Phone(s): Cell #: Email: Relationship to child(ren): Married Single

Walking

Grade

Male

Female

Male

Female

Room #

Child’s Full Name:

Please Check:

Wed

Sticker #

1

Please Check:

11:00

Room # I grant to Northridge Christian Church, it’s representatives, and employees the right to take photgraphs, video, and/or electronic images of any member of my family in our Family Ministry environments. I authorize Northridge Christian Church to copyright, use, and publish the photographs, video, and/or electronic images in print and/or electronically-with or without names-for any lawful purpose to highlight and promote our Family Ministry environments. My signature below indicates that I have read and understand the above statement of release.

Both Parents in Attendance

Parent Signature: