HOPE Children's Ministry Registration Form

Parent/Guardian Name 1 *
Parent/Guardian Name 1
Parent/Guardian Name 2 (spouse, etc)
Parent/Guardian Name 2 (spouse, etc)
Please note, this catagory is not required, however only names in the Parent/Guardian fields (1 and 2) and Emergency contacts are authorized to pick up the children listed on this form.
Phone *
Phone
Other Phone
Other Phone
Child's name *
Child's name
(MM/DD/YR)
Grade is determined by public schools deadline of age by September 30th for the beginning year of the current school years. Children are "promoted" or moved up to the next class in annually.
Authorized person's phone
Authorized person's phone
Emergency contact's phone *
Emergency contact's phone
Physician or pediatrician's phone
Physician or pediatrician's phone
PARENTAL MEDICAL AGREEMENT: Please check the box below indicating you have read and consent to the parental agreement for all children on this form *
Confirmed Parental Agreement
PARENTAL PHOTOGRAPHY/SOCIAL MEDIA AGREEMENT I give HOPE Presbyterian Church and its staff permission to take/use pictures and/or videos of my son/daughter (all children on this form) for purposes of publicity and promotion on hopechurchva.org, social media outlets and any work or promotion produced by the Children's Ministry and church. I understand that the worship services are live-streamed and if my child is in the front of the worship service may/will be on the live-stream distributed on social media, and by allowing them to come up front consent to them being on this live-stream/social media. *
If you have more than one child you would like to register with us, please continue below. Second Child's Name
If you have more than one child you would like to register with us, please continue below. Second Child's Name
NOTE- if the second, third or fourth child(ren) have different emergancy contacts, medical, photography/social media waiver consent/information- please submit this and use a new form for each child. Only name, grade, birthday, allergy, special needs are differentiated for each child.
(MM/DD/YR)
Third Child's Name
Third Child's Name
(MM/DD/YR)
Fourth Child's Name
Fourth Child's Name
(MM/DD/YR)