Children’s Ministry Online Registration

Please fill out one form for each of your children. This information will be shared with your child’s teacher(s). Thank you for your help in keeping our children safe while they are at Hominy Baptist Church.

Child's Name

First Name

Last Name

Date of Birth:

YYYY

Grade

Parents' Names

First Name

Last Name

Address

Emergency Phone Number:

(###)

###

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Additional Phone Number:

(###)

###

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Adults Who Can Pick Up My Child:

Allergies, Medications, Any Medical Conditions:

What Else You Should Know About My Child:

For Infants & Toddlers: Is Your Child Potty Trained

Special Instructions Regarding My Child: