ADONAI ENGLISH MINISTRY REGISTRATION FORM

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YOUTH INFORMATION

Please enter your information below.

Name

Address

Date of Birth

This address will receive a confirmation email

Phone (Cell Phone)

Grade

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Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th College University

Are you a member of the following ministries?

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Children Ministry Youth Ministry Young Adult Ministry Singles Ministry Bible Study Children Choir Youth Choir Young Adult Choir None

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PARENT/GUARDIAN INFORMATION

Parent's Full Name

Parent's Phone number

May we have permission to photograph your child?

Please select one option.

Yes No

May we have permission to use your child's photograph for the purpose of promotion?

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Yes No

Parent's photo

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OTHER SIBLINGS INFORMATION

Sibling (1) Full Name

Sibling (1) Date of Birth

Sibling (1) Grade

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Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th College University

Sibling (1) Photo

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Sibling (2) Full Name

Sibling (2) Date of Birth

Sibling (2) Grade

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Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th College University

Sibling (2) Photo

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Sibling (3) Full Name

Sibling (3) Date of Birth

Sibling (3) Grade

Please select one option.

Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th College University

Sibling (3) Photo

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List MEDICAL INFORMATION (Including any food allergies)

Electronic Signature (Parent, Please type your full name)

Please select all that apply.

** I understand that by entering my name in the box above, I am providing my digital signature on this Form. **

Description

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ADONAI ENGLISH MINISTRY REGISTRATION FORM

Description

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