Registration

If you are new to our church or have not attended Sunday morning Kids Ministry for a few months, please fill out this form completely to register your child.

Child's Name*

First Last

Service Time*

Select9:00am11:00am

I acknowledge that the registrant has my permission to participate in Pathfinder Kids Ministry. I understand that when participating in Kids Ministry activities the registrant may be photographed for print, video, or electronic imaging. I understand that the images may be used in promotional materials for Pathfinder Church. I acknowledge that the images will be the sole property of Pathfinder Church.

Photo Release*

I acknowledge.

Name*

Date*

MM slash DD slash YYYY

Child's Birthday*

MM slash DD slash YYYY

Gender*

SelectMaleFemale

Parent's Name (1)*

First Last

Parent's Name (2)*

First Last

Address*

Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Primary Number*

Primary Number Owner*

Whose Number Is This?MotherFatherOther

Alternative Number*

Alternative Number Owner*

Whose Number Is This?MotherFatherOther

Email*

Child's Grade Level (Fall 2022)*

For grades 6th-12th, visit Pathfinder Students

Select Grade LevelInfant (0-3 years old)Preschool (3-4 years old)Kindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade

School*

Is Your Child Baptized?*

SelectYesNo

If yes, date of Baptism*

MM slash DD slash YYYY

Does your child have any allergies or special needs?*

• Allergies
• Special Needs
• None

Please list any allergies we should know about.*

Special Needs Information

**Please Your child is a wonderful creation of God and deserves to be treated in such a manner. Pathfinder Church desires to assist you in the spiritual education of your child in accordance with their special considerations. Take a moment to fill out the special considerations that need to be used when working with your child. Be aware that the adults and youth who will be working with your child are volunteers and they may not be professionally trained in your child’s specific needs area. We ask you to also understand that communication between buddies, parents, and leaders is very important and be sure to inform everyone involved of important information that may change throughout the weeks or year.

I understand and agree that my child needs to be registered a minimum of 10 days prior to our visit, to ensure that Pathfinder staff has adequate time to find just the right buddy to connect with my child.*

• Yes
• No

Special Need:*

ie. Autism, ADHD, Down Syndrome, sensory needs, etc.

Medication/Medical Concerns:*

Developmental Age*

Potty Trained?*

• Yes
• No

Restroom Procedures*

Will your child be bringing items or a bag from home?*

• Yes
• No

Accommodations or Supports*

• Sensory Room
• Fidgets
• Seat Cushion
• Gum
• Breaks during activity
• Provide redirection
• May run away
• Movement area
• Weighted vest
• Moveable seat / exercise ball
• Frequent reminders
• Closest proximity to child
• Headphones / earplugs
• Other

If Other, please list below:

Do you have any special instructions or tips to help us meet the needs of your child?*

Please list any other information that is helpful to us:*

When is a good time for the Coordinator to reach you to discuss a buddy for your child?*

Are you interested in serving in Kids Ministry?*

SelectYesNo

HEALTH PARENT CONSENT

In order to ensure the health and wellness of children and volunteers, we ask that sick children not attend Kids Ministry programming. The Committee for Control of Infectious Diseases of the American Academy of Pediatrics recommends that a child should not leave home when any of the following symptoms exist:

• Within the last 24 hours:
  • Fever (over 100.5 degrees),
  • Any symptom of COVID-19
    • Fever or chills
    • Cough
    • Shortness of breath or difficulty breathing
    • Fatigue
    • Muscle or body aches
    • Headache
    • New loss of taste or smell
    • Sore throat
    • Congestion or runny nose
    • Nausea or vomiting
    • Diarrhea
  • Childhood diseases such as scarlet fever, German measles, mumps, chicken pox or whooping cough
  • Common cold - from onset through one week
  • Sore throat
  • Croup
  • Any unexplained rash
  • Any skin infection - boils, ringworm or impetigo
  • Untreated pink eye or other eye infection
  • Lice, including the presence of eggs or nits
  • Any communicable disease

If children become ill during their time with us, they will be separated from other children until they can be picked up. A staff member will text the parents.

I agree to follow current guidelines and to be as supportive of Pathfinder Kids as they strive to make the best possible environment for student’s health, safety, and learning.

Health Consent*

I acknowledge.