U18 Registration

Please fill out the form below to register your child for one of our U18 Ministries.

Program *

Child's Name *

First

Last

M/F

Child's Date of Birth *

Month/Day/Year

Address (Number/Street/Town/Postal Code)

Parent/Guardian Name *

First

Last

Address if different from child

Home Phone *

if you don't have a home phone, complete with your cell number

Cell Phone

Home Church (if applicable)

Email *

Name of Emergency Contact (if necessary) *

First

Last

Emergency Contact Phone Number(s) *

Emergency Contact's Relation to Child *

My child has allergies, health concerns, or is special needs *

Please explain any other health concerns or relevant information

Pictures of my child may be taken during any program and may be used for in-house purposes: slideshows, games, media presentations, etc *

Signature of Parent/Guardian *

By typing your name in this box you are applying your electronic signature, making it an official document for our record.

Today's Date *

Phone

Hanover Missionary Church