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First Child *
First Child
Child's Birth Date *
Child's Birth Date
Guardian's Name *
Guardian's Name
Second Child (fill out if applicable)
Second Child (fill out if applicable)
Second Child's Birth Date
Second Child's Birth Date
Third Child (fill out if applicable)
Third Child (fill out if applicable)
Third Child's Birth Date
Third Child's Birth Date
Fourth Child (fill out if applicable)
Fourth Child (fill out if applicable)
Fourth Child's Birth Date
Fourth Child's Birth Date
Fifth Child (fill out if applicable)
Fifth Child (fill out if applicable)
Fifth Child's Birth Date
Fifth Child's Birth Date
I Want to Help
Sign me up as a volunteer! (A CCE ministry application must be completed and backround checks are performed. We Love Our Kids!)
Address *
Address
Main Phone *
Main Phone
Alternate Phone *
Alternate Phone
Medical information we need to know (please include any allergies) Please list the name of your child and their condition. EXAMPLE: Mary has a nut allergy. John has epilepsy
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact Number 1 *
Emergency Contact Number 1
Emergency Contact 2
Emergency Contact 2
Emergency Contact Number 2
Emergency Contact Number 2
Who may pick up your child?
Do You Attend Church?
May we have permission to Photograph your child? *
May we have permission to use your child's photograph in church publications for the purpose of promotion? *