HOPE Children's Ministry Registration Form

Parent/Guardian Name *
Parent/Guardian Name
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 30, 2015. 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 AGREEMENT: Please check the box below indicating you have read and consent to the parental agreement *
Confirmed Parental Agreement
I give HOPE Presbyterian Church and its staff permission to take pictures and/or videos of my son/daughter 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.
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
(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)