Registration

Child(ren) Information
This field must contain Child's Name
This field must contain Child's Name
This field must contain birthdate
This field must contain age
This field must contain the grade
This field must contain the your school

* Required if applicable

Parent(s) Information
This field must contain Parent/Guardian Name
This field must contain phone number
This field must contain Parent/Guardian Name
This field must contain Parent/Guardian Name
This field must contain Parent/Guardian Name

Required

Emergency Contact Information
This field must contain Parent/Guardian Name
This field must contain phone number
This field must contain Relationship

Required

People who have permission to pick up my child(ren) when I am unable
This field must contain phone number
This field must contain phone number

* Required if applicable

Medical
Liability

I release and agree to hold harmless Shoreline Community Church, it's staff and volunteers from any liability for illness or injury while my child is enrolled in Children's Ministry Activities, and I agree to pay for all medical expenses.

Required

Permissions

I give permission for photos to be taken of my child participating in activities used only for Shoreline promotional materials.

I give permission for my child to be transported in a vehicle for Children's Ministry related activities.

Required

Payment Method

Required

Signature
This field must contain your signature
This field must contain the date
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