Children's Ministry Information Form

Child's Name

Child's Birthday

Parents Name

Address

Phone

This address will receive a confirmation email

Can we contact you through text message?

Yes No

Allergies

Emergency Contact Name

Emergency Contact Phone Number

Is there anyone that cannot pick up your child?

Do you give permission to Russellville Baptist to photograph your child? (Photos may be used on the website)

yes no

Description

Please fill out this form and click submit.