2026-2027 Children's Ministries Registration Form
Please use this form to register your children for Glen Ellyn Covenant Church programs!
Parent 1 Name
*
Parent 1 Email
*
This address will receive a confirmation email
Parent 1 Cell #
*
Parent 1 Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Parent 2 Full Name
Parent 2 Email
This address will receive a confirmation email
Parent 2 Cell #
Parent 2 Address (if different from Parent 1)
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Emergency Contact Name and Cell #
*
Child 1
Child 1 Full Name
*
Child 1 Birthdate
*
Child 1 Grade
*
Child 1 Designated caregivers (adults 18 ys+ who can sign out child)
ALLERGIES/MEDICAL: My child has allergies or medical concerns submitted in a
*
Please select all that apply.
Agree
No allergies/medical concerns
PHOTO CONSENT: I authorize Glen Ellyn Evangelical Church to take photos of my child and use them for publications within the church, the church website, and/or the church's social media pages.
*
Please select all that apply.
Agree
Photos that include my child will not be used or shared by GEECC
DIAPER CHANGE: I authorize the children’s ministry staff and/or adult volunteers to change my child's diaper when wet or soiled.
Please select all that apply.
Agree
Text me for diaper changes
BATHROOM HELP: I authorize the children’s ministry staff and/or adult volunteers to assist my potty-training child when he or she requests help.
Please select all that apply.
Agree
Text me when my child needs to use the bathroom
Child 2
Child 2 Full Name
Child 2 Birthdate
Child 2 Grade
Child 2 Designated caregivers (adults 18 ys+ who can sign out child)
ALLERGIES/MEDICAL: My child has allergies or medical concerns submitted in a
Please select all that apply.
Agree
No allergies/medical concerns
PHOTO CONSENT: I authorize Glen Ellyn Evangelical Church to take photos of my child and use them for publications within the church, the church website, and/or the church's social media pages.
Please select all that apply.
Agree
Photos that include my child will not be used or shared by GEECC
DIAPER CHANGE: I authorize the children’s ministry staff and/or adult volunteers to change my child's diaper when wet or soiled.
Please select all that apply.
Agree
Text me for diaper changes
BATHROOM HELP: I authorize the children’s ministry staff and/or adult volunteers to assist my potty-training child when he or she requests help.
Please select all that apply.
Agree
Text me when my child needs to use the bathroom
Child 3
Child 3 Full Name
Child 3 Birthdate
Child 3 Grade
Child 3 Designated caregivers (adults 18 ys+ who can sign out child)
ALLERGIES/MEDICAL: My child has allergies or medical concerns submitted in a
Please select all that apply.
Agree
No allergies/medical concerns
PHOTO CONSENT: I authorize Glen Ellyn Evangelical Church to take photos of my child and use them for publications within the church, the church website, and/or the church's social media pages.
Please select all that apply.
Agree
Photos that include my child will not be used or shared by GEECC
DIAPER CHANGE: I authorize the children’s ministry staff and/or adult volunteers to change my child's diaper when wet or soiled.
Please select all that apply.
Agree
Text me for diaper changes
BATHROOM HELP: I authorize the children’s ministry staff and/or adult volunteers to assist my potty-training child when he or she requests help.
Please select all that apply.
Agree
Text me when my child needs to use the bathroom
Child 4
Child 4 Full Name
Child 4 Birthdate
Child 4 Grade
Child 4 Designated caregivers (adults 18 ys+ who can sign out child)
ALLERGIES/MEDICAL: My child has allergies or medical concerns submitted in a
Please select all that apply.
Agree
No allergies/medical concerns
PHOTO CONSENT: I authorize Glen Ellyn Evangelical Church to take photos of my child and use them for publications within the church, the church website, and/or the church's social media pages.
Please select all that apply.
Agree
Photos that include my child will not be used or shared by GEECC
DIAPER CHANGE: I authorize the children’s ministry staff and/or adult volunteers to change my child's diaper when wet or soiled.
Please select all that apply.
Agree
Text me for diaper changes
BATHROOM HELP: I authorize the children’s ministry staff and/or adult volunteers to assist my potty-training child when he or she requests help.
Please select all that apply.
Agree
Text me when my child needs to use the bathroom
Submit
Description
Please use this form to register your children for Glen Ellyn Covenant Church programs!
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