Children's Church Registration New

Please fill out this form and click submit.

At least one parent's name and contact information is required to register child. Anyone expected to pick up child must be registered.

What motivated you to visit Amity today?

*

Please select all that apply.

Attending special occasion (guest speaker, visiting family, etc) Searching for a church home Invited by Amity member

Please tell us about parent #1 or adult checking child(ren) in.

Name

*

Status

*

Please select all that apply.

First Time Frequent Attender Amity Steward\( I have completed Steward Orientation)

I am the child's.

*

Please select all that apply.

Parent Other Relative Friend

Gender

*

Please select all that apply.

Male Female

Marital Status

*

Please select all that apply.

Single Married

Date of Birth

*

Mobile Phone

*

Email

*

This address will receive a confirmation email

Address

*

If an emergency arises we will contact the parent's first. If unsuccessful, we will call EMERGENCY CONTACT on file.

Emergency Name and phone contact

*

My child is between the ages of 0 - 12

*

Please select all that apply.

No Yes

Tell Us About Parent #2. If parent will pick up child they must register.

Parent #2 Name

Date of birth

Gender

Please select all that apply.

Male Female

Mobile Phone

Email

If parents have same address, please leave blank.

Enter Information for Child #1. If you drop off your child, you must remain in the building.

First Name #1

*

Last Name of Child #1

*

Child's Gender

*

Please select one option.

Girl Boy

Birthdate of Child #1

*

Grade of Child

*

Please list child's allergies or special needs'.

*

Enter Information for Child #2

First Name

Last Name

Child's Gender

Please select all that apply.

Girl Boy

Birthdate of Child #2

Grade of Child

List child's allergies or special needs.

I am the child's

Please select all that apply.

Parent Friend Other Family Member

Enter Information for Child #3

First Name of Child

Last Name of Child

Child's Gender

Please select all that apply.

Girl Boy

Birthdate of Child #3

Grade of Child

Please list child's allergies or special needs

I am the child's ...

Please select all that apply.

Parent Friend Other Family Member

Enter Information for Child #4

First Name

Last Name

Child's Gender

Please select one option.

Girl Boy

Birthdate of Child #4

Grade of Child

Please list child's allergies or special needs.

I am the child's ...

Please select all that apply.

Parent Friend Other Family Member

Description

Please fill out this form and click submit.

Please Fix the Following

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