VINEYARD KIDS' MINISTRY REGISTRATION FORM

This form will allow you to submit a Kids' Ministry Registration Form online. Please note that the * indicates that the information is required in order for the form to be submitted. Thank you!

CHILD'S INFORMATION
NAME *
NAME
Please list any allergies or medical conditions we should know about. If there are none, please type the word "NONE" below.
PARENT / GUARDIAN 1 *
PARENT / GUARDIAN 1
PHONE # - Parent / Guardian 1 *
PHONE # - Parent / Guardian 1
TYPE OF PHONE # *
ADDRESS - Parent / Guardian 1 *
ADDRESS - Parent / Guardian 1
PARENT / GUARDIAN 2
PARENT / GUARDIAN 2
PHONE # - Parent / Guardian 2
PHONE # - Parent / Guardian 2
TYPE OF PHONE #
ADDRESS - Parent / Guardian 2
ADDRESS - Parent / Guardian 2
Please list the names of anyone other than the Parent / Guardian who have permission to pick this child up from Kids' Ministry. If there are none, please type the word "NONE" below.
May we use this child's image in church publications? *
Would you like to receive Kids' Ministries updates via email? *
I am interested in volunteering for Kids' Ministries. *