Children’s Ministry Registration

Family Name (required)

Child's Full Name (required)

Father's Name (required)

Mother's Name (required)

Complete Address (required)

Phone Number (required)

Email (required)

Child's Birth Date (required)

Child's Age or Grade (required)

Incase of an emergency I give my permission to the staff of Warren Community Fellowship
to secure the services of a licensed physician to provide the care necessary, including
anesthesia.
Medical Release Accepted

Emergency Contact Person (required)

Emergency Contact Phone (required)

Allergies (if any)

Any additional information you would like to provide

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