Childcare Pre-registration

If you and your family will be joining us for the first time and you have children that will be attending our children's ministry, please fill out the form below to pre-register your family.

shiloh children's ministry

Mother's Name

First Name

Last Name

Mother's Phone

(###)

###

####

Mother's Email Address

Father's Name

First Name

Last Name

Father's Phone

(###)

###

####

Father's Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Child 1 Name

First Name

Last Name

Child 1 Birthday

MM

DD

YYYY

Child 2 Name

First Name

Last Name

Child 2 Birthday

MM

DD

YYYY

Child 3 Name

First Name

Last Name

Child 3 Birthday

MM

DD

YYYY

Child 4 Name

First Name

Last Name

Child 4 Birthday

MM

DD

YYYY

Child 5 Name

First Name

Last Name

Child 5 Birthday

MM

DD

YYYY

Child 6 Name

First Name

Last Name

Please list any known allergies or medical concerns we should be aware of as we care for your children:

Additional Notes