Joyful Givers 2026 Registration Form

If registering multiple children, please register each child individually.

Date

Child's Preferred Name (First & Last)

Person Registering Child's Full Name

Relationship to Child

Parent Grandparent Neighbor Adult Friend Other

Registering Person's Phone Number

Registering Person's Email Address

Emergency Contact Person's Name (Other than person registering the child)

Emergency Contact's Relationship to Child

Parent Grandparent Neighbor Adult Friend Other

Emergency Contact's Phone Number

How many people and (their ages) live in your household that your child will be

PLEASE NOTE - CHILDREN NEED TO BRING A SACK LUNCH.

Grade During the 2026 - 2027 School Year

Any known food allergies? If so, please explain.

Any medical concerns that we should be aware of that may come up during the event or in the case of an emergency? If so, please explain.

Any behavioral or emotional concerns that may come up during the event that we should be aware of so we are able to provide your child with the best experience? If so, please provide any tips or suggestions that you think would be helpful.

MEDICAL RELEASE - I, the parent/legal guardian of the child named above, a minor, do here authorize the leadership of Prairieview Covenant Church in New Richmond, WI as agents for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care or service, which is deemed advisable and is to be rendered to said minor, under the general or specific supervision of any physician and surgeon licensed, or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being rendered, and is given as specific consent to any all such diagnosis, treatment, or hospital care which the treating healthcare professional, in the exercise of their best judgment, may deem advisable to protect the life and health of said minor child.

I agree to the medical release described above. I do NOT agree. I do not want any medical treatment provided without my consent.

MEDIA RELEASE: Please select one of the options below. To protect your child's privacy, know that children will never be named, captioned, tagged, or otherwise identified in any published media without parental consent.

I give permission for Prairieview Covenant Church to use any photos or video recordings that may include my child in church publications, website, printed materials, and social media channels for ministry and promotional purposes. I DO NOT give permission for Prairieview Covenant Church to use any photos or video recordings that may include my child.

Do you have a home church that you regularly attend?

Yes No Rather not answer

If you don't have a home church, would you like to be contacted by our pastor or children's ministry director to learn more about Prairieview?

No Thanks Yes - Pastor Yes - Children's Ministry Director Doesn't Apply to Us

How did you find out about this event?

At Church Weekly Newsletter Facebook Word of Mouth Other

Joyful Givers 2026 Registration Form

Description

Please Fix the Following