New Discipleland Kids Form.ai - Rhema South Family Church

Visitors
form
SOUTH FAMILY CHURCH
1st time visitor
Service Time: 8.15am
Child’s Details
Name: (Please print clearly)
Surname:
10.30am
(Please print clearly)
1
2
3
4
Name: (Please print clearly)
Name: (Please print clearly)
Name: (Please print clearly)
Surname:
(Please print clearly)
Surname:
(Please print clearly)
Surname:
(Please print clearly)
5.30pm
Other:
Date of Birth
Gender
dd / mm / yyyy
BOY GIRL
Date of Birth
Gender
dd / mm / yyyy
BOY GIRL
Date of Birth
Gender
dd / mm / yyyy
BOY GIRL
Date of Birth
Gender
dd / mm / yyyy
BOY GIRL
Allergies: ________________________________________ Special Needs: ________________________________________
Parent/Guardian 1 Details (18yrs+)
Surname:
Name:
Date of Birth:
Email:
Relationship to child:
dd / mm / yyyy
Cell:
Father
Mother
Grandparent
Aunt
Uncle
Guardian
Parent/Guardian 2 Details (18yrs+)
Surname:
Name:
Date of Birth:
Email:
Relationship to child:
dd / mm / yyyy
Cell:
Father
Mother
Grandparent
Aunt
Uncle
Guardian
Volunteer Name: ___________________________________________ Date: ______________________________________
Disclaimer
•
I understand that my child/ren will be supervised for the duration of the service, and that I
am responsible for their collection immediately after the service.
•
I understand that I will only
. gain access to Children’s Church upon presentation of my
parent/guardian sticker
•
.
I understand that my child/ren will only be released to me upon presentation of my
parent/guardian sticker
•
Should the need arise for the duration of the time that my child is at Childrens Church, I give
obtain necessary medical treatment in the case
of an emergency.
•
I give permission to the Children’s Church Service Manager and volunteers to do any
necessary reprimanding, but I agree to be called out of the service to do any necessary
disciplining.
•
I will keep my cellphone on silent and on me at all times during the service, in case I need to
be contacted by Children’s Church for any reason and in case of an emergency.
•
As parent/guardian of the registered child, I will remain on Rhema South Family Church
campus for the duration of the service. Should I need to leave the campus for any reason, I
will collect my child/ren and leave with them.
or volunteers will not be held responsible for any injuries to my child/ren or loss of damage
to any property.
I agree to the above disclaimer
Sign:________________________________