Child Information Sheet

* Child's Name:

* Child's Sunday School Class/Teacher:

* Child's Wednesday Night Class/Teacher:

* Birth Date (mm/dd/yyyy):

* School District:

School:

* Homeschooled:
Yes
No

* Grade:

* Allergies/Important Medical Information:

* Parent's Names:

* Parent's Sunday School Class/Location:

* Parent's Wednesday Night Class/Location:

* Address:

* Phone Number:

Cell Number:

Email Address:

* Individuals authorized to pick up your child other than parents:

* Siblings:

Extracurricular activities your child is involved in:

Child's interests or other useful information:

I give my permission to use photos and/or video of my child in MBC promotional materials.