Mt. Ruhama Baptist Church - Children's Information Form 24-25

This information makes sure we have all of your child's information correctly recorded and that we know how to contact you!

Child's Name

Birthdate

Parent/Guardian Name

Relation to child

Phone Number

Email

Secondary Parent/Guardian Name (Optional)

Secondary Parent Relation to child

Secondary Parent/Guardian Phone Number (Optional)

Does your child have any siblings?

Yes

No

Names and ages of siblings

Does your child go to school yet?

Yes

No

Where does your child go to school?

Does your child participate in extracurricular activities?

Yes

No

Please list the activities

Does you child have any allergies or medical conditions?

Yes

No

Please List Allergies and/or Conditions

Is there anyone else, other than who is listed on this form, who is permitted to pick up your child from church events?

Yes

No

Please list the people, you give permission to pick up your child. (Name, Relation to your child, and phone numbers)

Signature

Children's Information form 24-25