Mount Vernon

Child Registration

Number of children you wish to register

What church does your family attend?

Child 1 First Name

Last Name

Birthdate

Grade

Allergies

What do we need to know to teach and serve this child most effectively?

Child 2 First Name

Last Name

Birthdate

Grade

Allergies

What do we need to know to teach and serve this child most effectively?

Child 3 First Name

Last Name

Birthdate

Grade

Allergies

What do we need to know to teach and serve this child most effectively?

Child 4 First Name

Last Name

Birthdate

Grade

Allergies

What do we need to know to teach and serve this child most effectively?

Child 5 First Name

Last Name

Birthdate

Grade

Allergies

What do we need to know to teach and serve this child most effectively?

Parent/Guardian 1 First Name

Last Name

Parent/Guardian 1 Phone Number

Parent/Guardian 2 First Name

Last Name

Parent/Guardian 2 Phone Number

Contact Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Contact Email

Would you like to add an additional emergency contact?

Yes

Emergency Contact First Name

Last Name

Emergency Contact Phone Number

please list all people authorized to pick up your child from AWANA.

MEDIA RELEASE: Do you authorize your child's image to be used at Mount Vernon Baptist Church and on MVBC web platforms?

YES, my child's image may be used.

NO, my child's image may not be used.

Signature for Medical Release

< Back

Next >

Submit

Mount Vernon

Child Registration

Contact Info

Follow Us