Children's Worship Registration • New St. John Baptist Church

Your kids are invited to join us every 1st, 3rd, and 4th Sunday of the month for a worship experience they won't forget. From arts and crafts, to storytelling, to showing them how God loves them, we cover it all! Simply drop your kids off in the Fellowship Center for breakfast at 7:45am CST, or the Education Building downstairs, and we will take it from there!

Children's pick-up is immediately following Adult Church Service. Please note, if your children have any special needs or allergies, we must be notified in the form below).

*Pre-registration is required prior to attending Children's Worship service.

Please complete a form for each child.

Parent's First Name *

Parent's Last Name *

Email Address *

Phone Number *

Mobile Number

Home Address *

Home Address Line 2

Home City *

Home State *

Home Zip Code *

Child's First Name *

Child's Last Name *

Date of Birth *

Child's Age *

School Grade *

Please give the name, relationship, and phone number of persons you authorize to pick up your child in your absence. Your child will not be released to anyone not listed.

Authorized Person Name (1)

Relationship to Child (1)

Authorized Person Phone (1)

Authorized Person Name (2)

Relationship to Child (2)

Authorized Person Phone (2)

Authorized Person Name (3)

Relationship to Child (3)

Authorized Person Phone (3)

Alternate emergency contacts:

Emergency Contact (1) *

Emergency Contact Relationship to Child (1) *

Emergency Contact Phone (1) *

Emergency Contact (2)

Emergency Contact Relationship to Child (2)

Emergency Contact Phone (2)

Are there any family situations we should be aware? Ex: custodial issues, specific person not to pick up your child, other matters (please specify)

Privacy Information

The information on this form will be used for the primary purpose of New St. John Baptist Church and Children’s Worship and may be used for any activities conducted or promoted by Children’s Worship. If you do not want this information to be used for any other purpose other than Children’s Worship, please notify Children’s Worship in writing.

Consent & Authorization

Permission to Participate in Program Activities *

I consent to my child taking part in the approved program of activities of Children’s Worship.

Permission to View Video Tapes and DVDs *

I consent to my child viewing VHS tapes /DVDs rated (G) General as well as viewing internet videos/materials applicable to lessons. I understand that all material will be previewed by Children’s Worship leaders to check suitability.

Permission to be Photographed or Filmed *

I give my permission for my child to be photographed or videotaped. I understand that the image may be displayed in church publications, church buildings or website. I understand that as a precaution my child’s name will not be published or linked with photographs.

Medical Authorization *

I authorize New St. John Baptist Church and Children’s Worship leaders in charge where unable to communicate with me or emergency contacts, to arrange for my child to receive such medical treatment as the leader/s may deem necessary at any time during the activities of Children’s Worship.

Treatment Authorization *

I further authorize the use of ambulance and/or medical treatment by a qualified medical practitioner if in his/her judgement it is necessary. I accept responsibility for payment of all expenses associated with such treatment.

Hold Harmless Claim *

I understand that every care will be taken by New St. John Baptist Church and Children’s Worship leaders and will not hold them responsible for personal injury, loss or theft of property affecting my child.

Electronic Signature Consent *

By checking this box and typing my name below, I am electronically signing my application.

Name for Electronic Signature *

Form Submission Date *

Please complete a form for each child.

Please give the name, relationship, and phone number of persons you authorize to pick up your child in your absence. Your child will not be released to anyone not listed.

Alternate emergency contacts:

Confidential Medical Information

Privacy Information

Consent & Authorization