Child Information Sheet

* Child's Name:

* Birth Date (mm/dd/yyyy):

* Age/ Grade:

* School District:

School:

* Homeschool:
Yes
No

* Allergies/Important Medical Information:

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

* Parent's Names:

* Parent's Sunday School Class/Location:

* Parent's Wednesday Night Class/Location:

* Phone Number 1:

Phone Number 2:

* Address:

Email Address:

* Siblings:

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

Extracurricular activities, interests or other information about your child that would be helpful to know: