2021-2022 Children’s Ministry Registration If you are human, leave this field blank.Parent's InformationParent 1 First Name *Parent 1 Last Name *Parent 1 Email *Parent 1 Cell Phone *This is the phone we will use on Sunday AM to contact you in case of emergency.Parent 2 First NameParent 2 Last NameParent 2 EmailParent 2 Cell PhoneWe will use this as a secondary emergency contact number on Sunday mornings.Street Address *Apt. or Building numberCity *Zip Code *Family Phone * Information about your plans for the school yearOur family plans to:Return to all indoor Children's Ministries programming at Knox in September.Watch the case count numbers and make our decision to return to indoor programming accordingly.Return to indoor Children's Ministries programming only when my child has been fully vaccinated.We'd like to register for:Childcare during worship (ages 0-3)Children's Worship (pre-K- 2nd grade)Christian Education Hour (all ages)Wednesday Night Midweek Kid's Club (K-6th grade) Information about ChildChild First Name *Child Last Name *Child's Date of Birth *What class are you registering this child for during the 2021-2022 school year? *Note: We ask that children be registered for the class that matches the class they are, or will be, in in school.Nursery (birth - 15 months or walking, by Sept. 1, 2021)Toddler 1 (15 months and walking by Sept. 1, 2021)Toddler 2 (2 yrs. old by Sept. 1, 2021)Toddler 3 (3 yrs. old, by Sept. 1, 2021)Pre-Kindergarten (entering Kindergarten in Sept. of 2022)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeDoes this child have any allergies, e.g. to medication, environmental factors or food (including food intolerances)? *YesNoIf so, please describe:Does this child have any additional medical conditions? *YesNoIf so, please describe:Is this child receiving any support services for developmental or learning concerns (such as an IEP or 504 Plan)?YesNoIf yes, have you already filled out a Special Blessings Intake Form?YesNoWould you be willing to? Doing so would give us information that will assist us in caring for your child, even if you do not desire specific involvement from the Special Blessings Ministry.YesNo, thank youThank you.Please complete the Special Blessings Intake Form. Is there anything else we should know about this child, and the learning environment in which s/he best thrives?e.g. Sensory sensitivities or physical limitationsYesNoIf so, please describe:Would you like to be contacted about our Special Blessings ministry for children needing additional support in order to participate successfully in our programs?Yes, PleaseNo, Thank YouSnacks are given to the children during most programs. We provide pretzels, animal crackers and Goldfish crackers for elementary age children. Early childhood groups are served Cheerios, Life cereal and Goldfish crackers. These are all nut free.PLEASE NOTE: We CANNOT guarantee that these have been produced in facilities that do not also produce food containing nuts. May we give this child these snacks? *YesNoIf this child is not able to eat the snacks we typically provide, will you be providing your own snack? (Note: Please notify room staff that you are providing a substitute snack.)YesNoWould you like to register another child? *YesNo Information about Child 2Child First NameChild Last NameChild's Date of BirthWhat class are you registering this child for during the 2021-2022 school year?Note: We ask that children be registered for the class that matches the class they are, or will be, in in school.Nursery (birth - 15 months or walking, by Sept. 1, 2021)Toddler 1 (15 months and walking by Sept. 1, 2021)Toddler 2 (2 yrs. old by Sept. 1, 2021)Toddler 3 (3 yrs. old, by Sept. 1, 2021)Pre-Kindergarten (entering Kindergarten in Sept. of 2022)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeDoes this child have any allergies, e.g. to medication, environmental factors or food (including food intolerances)?YesNoIf so, please describe:Does this child have any additional medical conditions?YesNoIf so, please describe:Is this child receiving any support services for developmental or learning concerns (such as an IEP or 504 Plan)?YesNoIf yes, have you already filled out a Special Blessings Intake Form?YesNoWould you be willing to? Doing so would give us information that will assist us in caring for your child, even if you do not desire specific involvement from the Special Blessings Ministry.YesNo, thank youThank you.Please complete the Special Blessings Intake Form. Is there anything else we should know about this child, and the learning environment in which s/he best thrives?e.g. Sensory sensitivities or physical limitationsYesNoIf so, please describe:Would you like to be contacted about our Special Blessings ministry for children needing additional support in order to participate successfully in our programs?Yes, PleaseNo, Thank YouSnacks are given to the children during most programs. We provide pretzels, animal crackers and Goldfish crackers for elementary age children. Early childhood groups are served Cheerios, Life cereal and Goldfish crackers. These are all nut free.PLEASE NOTE: We CANNOT guarantee that these have been produced in facilities that do not also produce food containing nuts. May we give this child these snacks?YesNoIf this child is not able to eat the snacks we typically provide, will you be providing your own snack? (Note: Please notify room staff that you are providing a substitute snack.)YesNoWould you like to register another child?YesNo Information for Child 3Child First NameChild Last NameChild's Date of BirthWhat class are you registering this child for during the 2021-2022 school year?Note: We ask that children be registered for the class that matches the class they are, or will be, in in school.Nursery (birth - 15 months or walking, by Sept. 1, 2021)Toddler 1 (15 months and walking by Sept. 1, 2021)Toddler 2 (2 yrs. old by Sept. 1, 2021)Toddler 3 (3 yrs. old, by Sept. 1, 2021)Pre-Kindergarten (entering Kindergarten in Sept. of 2022)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeDoes this child have any allergies, e.g. to medication, environmental factors or food (including food intolerances)?YesNoIf so, please describe:Does this child have any additional medical conditions?YesNoIf so, please describe:Is this child receiving any support services for developmental or learning concerns (such as an IEP or 504 Plan)?YesNoIf yes, have you already filled out a Special Blessings Intake Form?YesNoWould you be willing to? Doing so would give us information that will assist us in caring for your child, even if you do not desire specific involvement from the Special Blessings Ministry.YesNo, thank youThank you.Please complete the Special Blessings Intake Form. Is there anything else we should know about this child, and the learning environment in which s/he best thrives?e.g. Sensory sensitivities or physical limitationsYesNoIf so, please describe:Would you like to be contacted about our Special Blessings ministry for children needing additional support in order to participate successfully in our programs?Yes, PleaseNo, Thank YouSnacks are given to the children during most programs. We provide pretzels, animal crackers and Goldfish crackers for elementary age children. Early childhood groups are served Cheerios, Life cereal and Goldfish crackers. These are all nut free.PLEASE NOTE: We CANNOT guarantee that these have been produced in facilities that do not also produce food containing nuts. May we give this child these snacks?YesNoIf this child is not able to eat the snacks we typically provide, will you be providing your own snack? (Note: Please notify room staff that you are providing a substitute snack.)YesNoWould you like to register another child?YesNo Information for Child 4Child First NameChild Last NameChild's Date of BirthWhat class are you registering this child for during the 2021-2022 school year?Note: We ask that children be registered for the class that matches the class they are, or will be, in in school.Nursery (birth - 15 months or walking, by Sept. 1, 2021)Toddler 1 (15 months and walking by Sept. 1, 2021)Toddler 2 (2 yrs. old by Sept. 1, 2021)Toddler 3 (3 yrs. old, by Sept. 1, 2021)Pre-Kindergarten (entering Kindergarten in Sept. of 2022)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th GradeDoes this child have any allergies, e.g. to medication, environmental factors or food (including food intolerances)?YesNoIf so, please describe:Does this child have any additional medical conditions?YesNoIf so, please describe:Is this child receiving any support services for developmental or learning concerns (such as an IEP or 504 Plan)?YesNoIf yes, have you already filled out a Special Blessings Intake Form?YesNoWould you be willing to? Doing so would give us information that will assist us in caring for your child, even if you do not desire specific involvement from the Special Blessings Ministry.YesNo, thank youThank you.Please complete the Special Blessings Intake Form. Is there anything else we should know about this child, and the learning environment in which s/he best thrives?e.g. Sensory sensitivities or physical limitationsYesNoIf so, please describe:Would you like to be contacted about our Special Blessings ministry for children needing additional support in order to participate successfully in our programs?Yes, PleaseNo, Thank YouSnacks are given to the children during most programs. We provide pretzels, animal crackers and Goldfish crackers for elementary age children. Early childhood groups are served Cheerios, Life cereal and Goldfish crackers. These are all nut free.PLEASE NOTE: We CANNOT guarantee that these have been produced in facilities that do not also produce food containing nuts. May we give this child these snacks?YesNoIf this child is not able to eat the snacks we typically provide, will you be providing your own snack? (Note: Please notify room staff that you are providing a substitute snack.)YesNoDo you have additional children to register?If so, we ask that you please finish the questions below and submit a new form. AuthorizationsGrades Prekindergarten - 2nd grade: You may authorize up to two people to pick up your child (or children).NOTE: Nursery, Toddler 1, Toddler 2 and Toddler 3 rooms use a pager and sign-in system for child drop-off & pick-up. The person picking up your child must have the pager. Would you like to authorize additional people?YesNo, only I (and my spouse, if applicable) can pick up my child or childrenNot applicable, (my child(ren) is/are not in this age group)NameRelationship to Child (or Children)Cell Phone NumberWould you like to authorize a second additional person to pick up your child (or children)?YesNoNameRelationship to Child (or Children)Cell Phone NumberStill photographs and videotapes may be taken of programs and events. Do you give permission for Knox Church to use your child(ren)'s picture(s) in the event that their image appears in a video or still picture?(choose one)Yes, for internal use only (no online photos or videos)Yes, for internal and online useNoI authorize the church staff and/or volunteers to act on my behalf to approve appropriate emergency, medical treatment in the event I cannot be reached.YesNo Mid-Week ProgramsIn addition to Sunday morning programs, I would like to register for or receive information about Kindergarten through 6th grade Wednesday evening programs.YesNoAdditional CommentsCaptcha *reCAPTCHA is required.Submit
