EEFC Kids Life Intake

Parent/Guardian Information

Parent/Guardian #1

This address will receive a confirmation email

Phone

Relationship to Child

Parent Grandparent Legal Guardian

Parent/Guardian #2

Phone

Relationship to Child Parent Grandparent Legal Guardian

Address Information (Primary residence of Child)

Authorization

List Name/s of adults (Over 16) authorized to pick up your child/ren:

Consent

I understand Elgin Evangelical Free Church may take photographs/videos of my child/ren for lawful purposes, including publicity and/or web content - no names will be used.

I understand

Child #1 Information

Child #1 Name

Child #1 Birthday

Child #1 Grade (School Year 26/27)

PreSchool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Child #1 Allergies/Special Needs:

If Child #1 is in the Nursery do you want our volunteers to change your child's diaper or do you want us to get you to change it??

Yes, the volunteers can change my child's diaper No, I prefer to change my child's diaper if needed Not Applicable

If Child #1 is in 2s & 3s are they potty trained?

Yes, My child is Potty trained No, my child is not potty trained My child needs some potty assistance and volunteers can help him/her with that My child needs some potty assistance and I would like someone to get me so Ican help him/her with that Not Applicable

Child #2 Information

Child #2 Name

Child #2 Birthday

Child #2 Grade (School Year 26/27) PreSchool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Child #2 Allergies/Special Needs:

If Child #2 is in the Nursery do you want our volunteers to change your child's diaper or do you want us to get you to change it??

Yes, the volunteers can change my child's diaper No, I prefer to change my child's diaper if needed Not Applicable

If Child #2 is in 2s & 3s are they potty trained?

Yes, My child is Potty trainedOption No, my child is not potty trained My child needs some potty assistance and volunteers can help him/her with that My child needs some potty assistance and I would like someone to get me so I can help him/her with that Not Applicable

Child #3 Information

Child #3 Name

Child #3 Birthday

Child #3 Grade (School Year 26/27) Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Child #3 Allergies/Special Needs:

Child #4 Information

Child #4 Name

Child #4 Birthday

Child #4 Grade (School Year 26/27) Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Child #4 Allergies/Special Needs

Child #5 Information

Child #5 Name

Child #5 Birthday

Child #5 Grade (School Year 26/27) Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

Child #5 Allergies/Special Needs

Description

Welcome to Kidslife at EEFC! We're excited to partner with your family. Please complete this form so we can get to know your child, keep accurate family information on file, and provide a safe, smooth check-in experience each week. Thank you for helping us serve your family well!

If you have any questions, please contact Kidslife@elginefc.org

EEFC Kids Life Intake

Description

Please Fix the Following