First Congregational Church Child Information Sheet (PK-12th grade)
To be in compliance with the United Church of Christ “Safe Conduct” Policy,
please provide the following information before leaving your child in our care.
First Congregational Church Child Information Sheet (PK-12th grade)
To be in compliance with the United Church of Christ “Safe Conduct” Policy,
please provide the following information before leaving your child in our care.
Child Name: __________________________________________________
Child Name: __________________________________________________
Age and Grade in School this year: ______________________________
Age and Grade in School this year: ______________________________
Child Birthdate: _______________________________________________
Child Birthdate: _______________________________________________
Child Allergies, etc.:_____________________________________________
Child Allergies, etc.:_____________________________________________
Learning needs or difficulties you would like us to know about:
_____________________________________________________________
Learning needs or difficulties you would like us to know about:
_____________________________________________________________
Parent(s) Name: _______________________________________________
Parent(s) Name: _______________________________________________
Parent Email: __________________________________________________
Parent Email: __________________________________________________
Phone number for emergency: ___________________________________
Phone number for emergency: ___________________________________
Home address:
Home address:
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
I would like to receive:
 Children, Teen, and Family Ministries Weekly Enews YES / NO
 Monthly Church Newsletter The Landmark YES / NO
 First Church “membership” emails YES / NO
 Information on baptism YES / NO
I would like to receive:
 Children, Teen, and Family Ministries Weekly Enews YES / NO
 Monthly Church Newsletter The Landmark YES / NO
 First Church “membership” emails YES / NO
 Information on baptism YES / NO
Our program requires the commitment and care of many volunteers. Please
indicate which age and discipline you would most enjoying helping with this
year.
Our program requires the commitment and care of many volunteers. Please
indicate which age and discipline you would most enjoying helping with this
year.
Nursery
ART
Pre-K/K
GAMES
1st/2nd
3rd
4th
STORY/VIDEO
5th/6th
7th/8th
9th-12th
SCIENCE/COOKING
Nursery
ART
Pre-K/K
GAMES
1st/2nd
3rd
4th
STORY/VIDEO
5th/6th
7th/8th
9th-12th
SCIENCE/COOKING
Photography Release
I understand that on occasion First Congregational Church of Guilford uses
photos on church bulletin boards and on its website for the purpose of sharing
our church’s ministries and educational programs. I also understand that the
church will never identify a child by name.
Photography Release
I understand that on occasion First Congregational Church of Guilford uses
photos on church bulletin boards and on its website for the purpose of sharing
our church’s ministries and educational programs. I also understand that the
church will never identify a child by name.
_____ I authorize First Church to use photos in which my child appears
_____ I authorize First Church to use photos in which my child appears
_____ I do not authorize First Church to use photos in which my child appears
_____ I do not authorize First Church to use photos in which my child appears
Signature of Parent/Guardian ______________________________________
Signature of Parent/Guardian ______________________________________
Date __________________________________________________________
Date __________________________________________________________