St. James' Children's Ministries Registration Form

Thank you for entering or updating information for your 3-12 year old child. (Please complete 1 form per child in your household.) The data you share helps St. James' better nurture your children and honor your parental preferences.

If you have questions about this form, please reach out to Rev. Erin.

Child's Name (first and last)

Child's Preferred Name

Date of Birth (mm/dd/yyyy)

Preferred Pronouns 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

Do we have permission to send you emails related to St. James' Children's Ministries?

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)

Allergies to Food

Allergies to Medicine

Other Important Information

Emergency Contact

Please share this person's name, contact information, and 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?

Yes No Please contact me about this.

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?

Yes No Please contact me about this.

Parent/Guardian Digital Signature

Full Name

Today's Date

St. James' Children's Ministries Registration Form

Description

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