CHILD CHECK-IN

Last Name of Family:

Street Address

City:

State:

ZIP Code

Parent location during church activities:

Phone

Primary Guardian (First and Last Name):

Marital Status

Child's Birthdate:

Primary Contact Phone Number

Contact Phone Type

Primary Guardian's Relationship to Child:

Name Spouse or Other Guardian:

List of People who are allowed to pick your child up from childcare/activities at Immanuel

Child #1 - Full Name

Child #1 - Gender

Child #1 - Birthdate

Child #1 - Grade

Child #1 - Allergies