Family Registration Form

~Regular Attenders~

First Name

 Last Name
 Gender
 Birthdate
 Age
 Entering Grade
 Special Needs, Allergies, Medical Concerns
    
  
  
  
  

Child(ren)'s Primary Address    City    Zip Code Phone Number:     
 Parent/Guardian Name:   
Parent/Guardian Phone: 

Address (if different from child"s) 

Email Address: 

We periodically take pictures of our UPStreet Children for use in promotional vidios, brochures, and on our website.  Please contact a member of the UpStreet Staff if you have questions or concerns regrding your child's image being used.

I understand that my family is one of many cared for in UpStreet.  By registering my family, I agree to supplement our regular volunteers by serving periodically in our UpStreet Children's Ministry.

Our family will attend the     service.

I prefer to serve in:    I prefer to serve on: