Marion First Church of God

Wednesday Night Children’s Ministry

Name (Required)

Email Address (Required)

Your Phone Number (Required)

Your Address (Required)

Additional / Emergency Contact Name

Additional / Emergency Contact Number

Additional / Emergency Contact‘s Relationship to Child

(e.g. grandmother, aunt)

Child’s Name (Required)

Please register one child at a time.

Child’s Birthday

Child’s School Grade Level (Required)

Child’s Allergies or Medical Info

After Grow, Child: (Required)

Can be picked up by mom

Can be picked up by dad

Can walk home

Other

Do we have permission to photograph and use your child’s likeness in newsletters? (Required)

Marion First Church of God

PO Box 477 | 702 Broadway Ave, Marion, SD 57053