Avenue T For Tots Registration - Avenue T church of Christ

Child's Information

Child's Name

First

Last

Preferred Name for Name Tag (if different from First Name shown above)

You can leave this blank if child prefers to be called by First Name shown above

Gender

Male
Female

Birthday

Age at Start of School Semester

Allergies, Medical, and Special Needs (please leave blank if none)

Please list any information that would be helpful for VBS staff to know about this child

May we have permission to photograph this child?

Yes
No

By granting permission for the church to photograph my child, I am also granting permission for the church to use my child’s photograph in internal and external school or church publications.

Other Info

Any other information for school staff

Parent / Guardian #1 Details

Parent / Guardian #1 Name

First

Last

Parent or Guardian #1 is automatically authorized to pick up child

Home Phone

Email

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Are you a member of the Avenue T Church of Christ?

Yes
No

If NO, do you attend church?

Yes
No

Please keep me updated on news, events from Avenue T Church of Christ.

Yes
No

Parent / Guardian #2 Details

Parent / Guardian #2 Name

First

Last

Home Phone

Email

Cell Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Are you a member of the Avenue T Church of Christ?

Yes
No

If NO, do you attend church?

Yes
No

Please keep me updated on news, events from Avenue T Church of Christ.

Yes
No

AUTHORIZED PICKUP List

Besides Parent(s) / Guardian(s), please list anyone else who is authorized to pick up child registered above.

Anyone picking up a Child from school: 1. Must be a Parent/Guardian OR must be on the Authorized Pickup List. 2. Must show Photo ID to school staff.

EMERGENCY CONTACTS

List of Emergency Contacts

In case of an emergency, school staff will attempt to contact Parent(s)/Guardian(s) first. Please list additional people school staff can call in an emergency if Parent(s)/Guardian(s) cannot be reached.