(605) 256-3027Monday - Friday 9am-3:00pm
Please fill out the form below to register your children for children's activities at WCB.
2021-2022 Registration Form
This form will be used for the entire Children's Ministry Program. Please select which areas you intend to register your child(ren) in for the year.
Name*
, AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Phone( ) -
( ) -
Email
Home Church
Name
Youth's Email
If attending youth activities (6th grade - 12th grade)
Youth's Cell Phone( ) -
Nursery (N - 2yr)
Children's Church (3yr-5yr)
Sunday School (3yr - 10th Grade)
Awana (1st Grade - 5th Grade)
Youth (6th Grade - 12th Grade)
Birthdate January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901
Male
Female
Grade (2021-2022) Nursery Preschool Jr. Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
Yes
No
If yes, explain:
*If child has allergies, please complete the Special Medical Needs Agreement Form.
Children's Church (3yr - 5yr)
Phone*( ) -
You as parent/guardian are responsible for checking your child(ren) in each day and will be required to sign your child out. You must communicate with the current teacher/leader if someone other than yourself will be picking up your child(ren).
I Understand the Check In/Check Out Process
I give permission to the following individuals to pick up the above listed child(ren):
Relationship to Child(ren)
In case of a medical emergency, I understand that first 911 will be contacted and then every effort will be made to contact the parents/guardians and emergency contacts listed. In the event that I cannot be reached, I hereby give permission to WCB volunteers to contact appropriate medical staff to provide necessary medical services in the event that my child/youth is injured or becomes ill. I authorize one or more of the following persons to make emergency medical care decisions on behalf of my child/youth: WCB Pastors and other adult volunteers designated by a pastor. I authorize these persons to act in my place to consent to all necessary care. I understand that WCB, staff, and volunteers will not be responsible for medical expenses incurred solely on the basis of this authorization. Parents/guardians are responsible for the medical insurance coverage while their child is attending events and activities. Medical treatment for any illnesses, injury, or medical situation for your child/youth will be billed to parents/guardians. I further agree to notify WCB of any health changes that would restrict my child’s/youth’s participation in any normal activities. I also understand that the WCB volunteers reserve the right to restrict my child/youth from any activity that they do not feel is within the physical capabilities of my child/youth.
I hereby certify that the above information is correct.
I hereby give WCB Church permission to use photography of the above named child only for bulletin boards, children’s nursery cubbies, church media, and special events (e.g., carnival, VBS) at WCB Church. Please check your response:
I consent to have my child participate in the above listed activities of the West Center Baptist Children’s Ministry program, and certify that I will hold West Center Baptist Church, its directors, employees, volunteers, or agents from any and all liability and claims arising out of participation in or in the connection with the program or West Center Baptist Children’s Ministry program.
I hereby certify that the above statement is correct.
© 2022 West Center Baptist | 322 W. Center Street, Madison, SD US 57042
