2023 St. James' Children's Ministries Registration Form

Please fill out this form and click submit.

Complete 1 form per child.

Be sure to review the Medical Consent and Media Release; of course, please respond according to your preferences as his/her/their parent.

If your child is a 6th-12th grader, please complete a youth form.

Child's Name (first and last)

Child's Preferred Name

Date of Birth (mm/dd/yyyy)

Preferred Pronouns

Please select one option.

he/him she/her they/them

Family Connections

Parent/Guardian #1 Name (first and last)

Parent/Guardian #1 Email

Parent/Guardian #1 Phone

Parent/Guardian #2 Name (first and last)

Parent/Guardian #2 Email

Parent/Guardian #2 Phone

Child's Email (if applicable)

Child's Phone (if applicable))

Sibling Names (if applicable)

About Your Child

Date and place of baptism (if applicable)

School (if applicable)

Grade (if applicable)

Please select one option.

Pre-Kindergarten Kindergarten 1st 2nd 3rd 4th 5th

Allergies to Food

Allergies to Medicine

Other Important Information

Emergency Contact

Please share this person's name, contact information, and this person's relationship to your child.

Authorization and Consent of Parent (s) or Legal Guardian for Medical Treatment

I grant my authorization and consent for St James’ Episcopal Church staff to administer general first aid treatment of any minor injuries or illnesses experienced by the Minor. I understand in an emergency situation, emergency services will be contacted.

Do we have permission to administer general first aid treatment of any minor injuries or illnesses experienced by your child?

Please select all that apply.

Yes No

Media Release

I understand that photos or videos or audio of my child may be taken during family ministries activities and/or other church events. I consent to the use of my child's photo, voice, or likeness in promotional materials such as the church website, newsletter, brochures, bulletin, and social media outlets. I understand that my child's identifying information will not be provided unless I give permission at a later time.

Do we have permission to photograph and record your child?

Please select all that apply.

Yes No

Parent/Guardian Digital Signature

Full Name

Today's Date

Description

Please fill out this form and click submit.

2023 St. James' Children's Ministries Registration Form

Description

Please Fix the Following