Mountain Movers Registration Form

MOUNTAIN MOVERS CHILD REGISTRATION

Child's Name

First Name

Last Name

Date of Birth

YYYY

Grade

Gender

Male

Female

Getting to Know Your Child

Favorite Activities

Does not like:

Is allergic to:

Has your child ever been left in child care before?

Yes

Does your child have any special words for things that we should know?

ex: "sisi" = pacifier

Snack

YES, my child can have snack

NO, my child cannot have snack

Additional snack information:

Parent/Guardian Information

Name

First Name

Last Name

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Who has permission to pick up your child from the nursery? (with the security sticker ONLY)

Media & Photo

Crow Hill Bible Church (CHBC) may take photography or videography during any CHBC sponsored activity. Your child's photograph (without their name) may be used in CHBC publications, on the CHBC website, on CHBC social media, and in news releases associated with any CHBC sponsored activity.

Parent/Guardian Signature