First Contact - Child Information
Please complete one form for each child.  
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Child's Name *
Child's Date of Birth (Please be mindful to change year) *
MM
/
DD
/
YYYY
Child's Primary Address *
Please identify any allergies that your child has *
Please identify any physical or behavioral special needs *
Parent/Legal Guardian Information
Please fill out the below information regarding the Parent/Legal Guardian for the child (even if this is not the person who brings the child to church)
Parent/Legal Guardian Name 1 *
Parent/Legal Guardian Name 2
The Legal Guardian will be the person primarily bringing *child's name* to church *
Required
Parent/Guardian Primary Email *
Telephone Number
Address *
Child lives at above address. *
Required
Relationship to the Child *
Sunday Morning Information
Please identify who brings your child to church on Sundays, acting as guardian in your absence.
My Child attends church with: (name) *
Relationship to child: *
Email Address for above:
Consent
Please read the following statements and select "yes" to confirm you agree before hitting submit.
I acknowledge and understand that all information collected, is for the sole purpose of the First Presbyterian Church and will not be shared by other parties. *
Required
I acknowledge and understand that by entering the premises of the First Presbyterian Church, or engaging in Church sponsored activities outside of the Church, consent to my child's voice and likeness being videotaped and used without compensation for use in any format or media channel now known, or hereafter devised as the First Presbyterian Church sees fit.  I further release the First Presbyterian Church and its assignees, licensees, directors, officers, employees, agents and contractors from any liability on account of such usage. *
Required
I understand that in the case of emergency, every effort will be made to make contact with parents or guardians immediately.  However, if parents or guardians cannot be reached, I hereby grant First Presbyterian Church to act on my behalf in seeking medical attention by contacting 911. *
Required
Name of Person completing the form *
If you have any questions or require additional information about First Contact, please contact Julia Sheffield at 705-445-4651 or youthatfirst@rogers.com
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