Child Information Form

Thank you for entrusting the care of your child to us. Your child is very important to us, and we look forward to learning together, playing together, and sharing the love of Jesus with him or her. Please complete and submit one form for each child you plan to entrust to our care during our Sunday worship service.

Your name *

Last name

Email address *

Phone Number

Phone type

Please complete the remainder of the form with your child's information.

Child's Name *

Birthday *

Grade

Gender *

Medical Note

Please let us know of any medical concerns or special intructions.

Please notify me during the service...

if my child cries at all

if my child cries longer than 5 minutes

if my child cries longer than 10 minutes

only in an emergency

How would you like us to notify you?

text my cell

find me in the service

What are some of your child's favorite things? (items from home, toys, activities)

If your child is crying, what are some ways that work best to comfort him or her?

Periodically we take photos or video of the children during children's ministry times. Do you give your permission for us to use your child’s image on Christ Presbyterian Church printed publications or website? *

Yes

Is it ok for us to give your child a snack? (pretzels, animal crackers, goldfish). If not, would you like to provide an alternative? *

If needed, is it okay for our volunteers to give your child first aid? *

Yes

Christ Presbyterian Church
cpcrva@gmail.com
804-282-4872

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