2025 Children's Ministries Registration Form

Please use this form to register your kids for Glen Ellyn Covenant Fall programs!

Parent 1 Name

*

Parent 1 Email

*

This address will receive a confirmation email

Parent 1 Cell #

*

Parent 1 Address

*

Parent 2 Full Name

Parent 2 Email

This address will receive a confirmation email

Parent 2 Cell #

Parent 2 Address

Emergency Contact Name and Cell #

*

Child 1

Child 1 Full Name

*

Child 1 Birthdate

*

Child 1 Grade

*

Child 1 Allergies

Child 1 Programs (Check all that apply)

*

Please select all that apply.

Sunday mornings Tuesday mornings Wednesday evenings

Child 1 Designated caregivers (adults 18 ys+ who can sign out child)

Child 2

Child 2 Full Name

Child 2 Birthdate

Child 2 Grade

Child 2 Allergies

Child 2 Programs (Check all that apply)

Please select all that apply.

Sunday mornings Tuesday mornings Wednesday evenings

Child 2 Designated caregivers (adults 18 ys+ who can sign out child)

Child 3

Child 3 Full Name

Child 3 Birthdate

Child 3 Grade

Child 3 Allergies

Child 3 Programs (Check all that apply)

Please select all that apply.

Sunday mornings Tuesday mornings Wednesday evenings

Child 3 Designated caregivers (adults 18 ys+ who can sign out child)

Child 4

Child 4 Full Name

Child 4 Birthdate

Child 4 Grade

Child 4 Allergies

Child 4 Programs

Please select all that apply.

Sunday mornings Tuesday mornings Wednesday evenings

Child 4 Designated caregivers (adults 18 ys+ who can sign out child)

Description

Please use this form to register your kids for Glen Ellyn Covenant Fall programs!

Please Fix the Following

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