FELLOWSHIP WESLEYAN CHURCH 716-675-9245 1645 Southwestern Blvd., West Seneca, NY 14224FELLOWSHIP WESLEYAN CHURCH

Children/Student Ministries Registration for 2018/19 year

This form is needed to comply with our Safe Child policy and is helpful to the ministry teams to plan accurately.  Fill it out once a year for the whole family.

Please fill out if you have children from 0-12th grade

Parent's Full Name (required)

Your Email (required)

Your Address (required)

City (required)

Zip code (required)

Home phone (required)

Cell phone (required)

Emergency Contact (required)

Emergency Contact phone number (required)

Alternate pick up info

From Nursery/ Sunday school:
From Wednesday Night/Student Impact:

Please make sure you answer the following questions:

1. I grant permission for my child's photo to be publications
Yes, with full nameYes, with first name onlyNo

2. Is there anyone that SHOULD NOT have contact with your child(ie: non-custodial parent, ect.)?

1. Child's Name

1. Child's Birthday
(YYYY-MM-DD)

1. Child's age:

1. Child's Grade:

Will be attending (check all that apply)

Sunday
NurseryJr. Church(4yrs-5th)Sunday school

Wednesday
Kids Club Jr. (3-5yrs)God's Girls (1st-5th)Girl's Impact (6th-12th)Ranger Kids (K-2nd)Discover Rangers (3rd-5th)Adventure Rangers (6th-8th)Expedition Rangers (9th-12th)

Allergies or Health Concerns

2. Child's Name

2. Child's Birthday

(YYYY-MM-DD)

2. Child's age:

2. Child's Grade:
Will be attending (check all that apply)
Sunday
NurseryJr. Church (4yrs-5th)Sunday school
Wednesday
Kids Club Jr. (3-5yrs)God's Girls (1st-5th)Girl's Impact (6th-12th)Ranger Kids (K-2nd)Discover Rangers (3rd-5th)Adventure Rangers (6th-8th)Expedition Rangers (9th-12th)

Allergies or Health Concerns

3. Child's Name

3. Child's Birthday

(YYYY-MM-DD)

3. Child's age:

3. Child's Grade:
Will be attending (check all that apply)
Sunday
NurseryJr. Church (4yrs-5th)Sunday school
Wednesday
Kids Club Jr. (3-5yrs)God's Girls (1st-5th)Girl's Impact (6th-12th)Ranger Kids (K-2nd)Discover Rangers (3rd-5th)Adventure Rangers (6th-8th)Expedition Rangers (9th-12th)

Allergies or Health Concerns

4. Child's Name

4. Child's Birthday

(YYYY-MM-DD)

4. Child's age:

4. Child's Grade:
Will be attending (check all that apply)
Sunday
NurseryJr. Church (4yrs-5th)Sunday school
Wednesday
Kids Club Jr. (3-5yrs)God's Girls (1st-5th)Girl's Impact (6th-12th)Ranger Kids (K-2nd)Discover Rangers (3rd-5th)Adventure Rangers (6th-8th)Expedition Rangers (9th-12th)

Allergies or Health Concerns

5. Child's Name

5. Child's Birthday

(YYYY-MM-DD)

5. Child's age:

5. Child's Grade:
Will be attending (check all that apply)
Sunday
NurseryJr. Church (4yrs-5th)Sunday school
Wednesday
Kids Club Jr. (3-5yrs)God's Girls (1st-5th)Girl's Impact (6th-12th)Ranger Kids (K-2nd)Discover Rangers (3rd-5th)Adventure Rangers (6th-8th)Expedition Rangers (9th-12th)

Allergies or Health Concerns

6. Child's Name

6. Child's Birthday

(YYYY-MM-DD)

6. Child's age:

6. Child's Grade:
Will be attending (check all that apply)
Sunday
NurseryJr. Church (4yrs-5th)Sunday school
Wednesday
Kids Club Jr. (3-5yrs)God's Girls (1st-5th)Girl's Impact (6th-12th)Ranger Kids (K-2nd)Discover Rangers (3rd-5th)Adventure Rangers (6th-8th)Expedition Rangers (9th-12th)

Allergies or Health Concerns

Additional Comments