New Family Registration

Are you new to Next Gen Ministry?
If it's you're child's first time attending any programming with us, we are happy to have you!
We ask that you please fill in the form below. 

New Family Registration Form

Date *
Date
Dad's Full Name *
Dad's Full Name
Dad's Cell *
Dad's Cell
Mom's Full Name *
Mom's Full Name
Mom's Cell *
Mom's Cell
Home Phone
Home Phone
Street Address *
Street Address
Child 1
First Child's Name
First Child's Name
Sex
Birthday
Birthday
Check all that apply:
Child 2
Second Child's Name
Second Child's Name
Sex
Birthday
Birthday
Check all that apply:
Child 3
Third Child's Name
Third Child's Name
Sex
Birthday
Birthday
Check all that apply:
Child 4
Fourth Child's Name
Fourth Child's Name
Sex
Birthday
Birthday
Check all that apply:
Waiver Portion; Required to complete if attending any Children, Preteen, or Teen programming at Regina Apostolic Church.
Please indicate which program year this waiver is for. *
Onsite Activities; I, the parent/guardian, give permission for my child(ren) to participate in all on site activities associated with Next Gen Programming. *
Offsite Activities; I, the parent/guardian, give permission for my child(ren) to participate in all offsite activities associated with Next Gen Programming. *
Injury; Although children & youth will be supervised and every effort will be made to prevent injuries, Regina Apostolic Church accepts no responsibility for any risk of injury for the children/youth while under our supervision. *
Photographs; I give permission for Regina Apostolic Church to produce and use any photograph of my child, for use on informational or promotional material. No names or person information will be attached to the images. *
Cards; May we have permission to send your child(ren) a note or card? *
Contact;May we have permission to contact your preteen/youth using the following...
Signature: By entering my name in the following box, I understand this will act as my legal signature and consent in agreement with the terms of this contract. *
Signature: By entering my name in the following box, I understand this will act as my legal signature and consent in agreement with the terms of this contract.