*Denotes Required Field * Title * Are you a visitor or new to Central Heights? Visitor New to Central Heights PARENT/GUARDIAN #1 Information * FIRST Name: * LAST Name: * Phone: ( ) - * Email: * Relationship to child(ren): (parent or other?) PARENT/GUARDIAN #2Information FIRST Name: LAST Name: Phone: ( ) - Relationship to child(ren): (parent or other?) KIDS INFO Please list names and birthdates of all the children in your household. * Name ----------------------- Birthdate (mm/dd/yy): NURSERY Can a screened volunteer change your child's diaper or would you prefer to be texted? Volunteer can change Text Me PRESCHOOL Can a screened volunteer assist your child in the bathroom? Yes No Anything else we need to know? MEDIA CONSENT * Understanding that Central Heights Church does not include names of minors with their pictures in any promotional material, I consent to the use of pictures/videos taken of my child at CHC kids events for website, promotional, social media and reporting purposes. Yes No * Would you like to stay updated on Kids Ministry via email? Yes No
