Child's Name *
Child's Name
Date of Birth *
Date of Birth
Gender *
if applicable
Family Information
Father's Name
Father's Name
Father's Cell Phone
Father's Cell Phone
Mother's Name
Mother's Name
Mother's Cell Phone
Mother's Cell Phone
Address
Address
Emergency Contact, other than parents:
Name
Name
Best Contact #
Best Contact #
For the safety of your child, people that will be dropping off and picking up, including parents
Name
Name
Name
Name
Media Release
My child's pictures can be taken and posted to the Kids Ministry Social Media pages and used in any Legacy Church promotional materials
Medical Information
Does your child have a life-threatening condition that could require emergency medication?
If yes, will you be sending this medication with your child to church?
Emergency Medical Authorization
I, the undersigned parent or guardian, do hereby authorize emergency