Southgate SDA Church

Guardian Name

Phone Number

Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Child 1

First Name

Last Name

Birthdate

Grade they are entering in the fall.

Child Medical information( Please list any allergies or other medical information we need to know about.)

Does your family attend a church?

Yes

No

Name of Church (if you answered "Yes" to the above question.)

May we have permission to photograph your child for our slideshow/ video?

Yes

No

May we have permission to use your child's photo on social media?

Yes

No

On the first day of VBS parents/ guardians are required to come in and sign waivers or the child/ children will not be allowed to participate in activities.

I understand

Child Registration

Child 1

About

Service Times

Contact Info

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