Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

What programming do you plan on bringing your children to? *

Select all that apply

Sunday School & Nursery (SUNDAYS)

WEDNESDAY Night Activities

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Child #1 *

First Name

Last Name

Son

Daughter

Birthdate *

MM

DD

YYYY

Child #2

First Name

Last Name

Son

Daughter

Birthdate

MM

DD

YYYY

Child #3

First Name

Last Name

Son

Daughter

Birthdate

MM

DD

YYYY

Child #4

First Name

Last Name

Son

Daughter

Birthdate

MM

DD

YYYY

Child #5

First Name

Last Name

Son

Daughter

Birthdate

MM

DD

YYYY

Photo Release *

By enrolling your children in Children’s Ministry, you consent to Haven Church’s use of your children’s photos and videos captured during programming. The purpose of these images and footage is to show the community that Haven Church is safe, fun, and a positive experience for many children and families. By clicking the box and sigining, you are digitally signing that you give Haven Church the permission to photograph my child and use his or her picture solely for the church’s website or Facebook page. Haven Church will never publish a child’s name with any of its publications. If you have any questions or need further assistance, please feel free to contact Haven Church’s Youth Director through email at jordan@myhavenchurch.org. Thank you for supporting your children’s spiritual formation! We look forward to providing a positive, engaging and exciting experience to learn about Jesus!

Yes, photographs of my child can be used in graphics for Haven Church.

No, please don't use photographs of my child for Haven Church advertisements.