Ministries

Parent/ Guardian Name

Parent/ Guardian Phone Number

Parent/ Guardian Email

Child Name (#1)

Child Name (#2)

Child Name (#3)

Children(s) Age & Grade

Allergies/ Medical Needs

Emergency Contact (if different than Parent/ Guardian)

Photo Release (I consent to photos/videos of my child being used for church-related purposes.) Yes No

Columbia Community Center of Seventh-day Adventists

9121 Red Branch Rd, Columbia, MD 21045-2057