Our check in system will soon be changing and we would like to ensure a smooth and convenient check in process for your family. Please fill out the following form so that we may have correct and current information for your family. Thank you so much for taking the time to update your family’s information!

Parent / Guardian Name

First Name

Last Name

Family Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Would you like to be included on our email list?

Yes

Email Address

Additional Info

Specify the person(s) authorized to drop off and pick up your child(ren). (Please include phone number.)

Parent / Guardian Name

First Name

Last Name

Phone

(###)

###

####

Parent / Guardian Name

First Name

Last Name

Phone

(###)

###

####

Children Info

Child's Name 1

First Name

Last Name

Birthdate

YYYY

Age

Grade

Allergies/Special Instructions

Child's Name 2

First Name

Last Name

Birthdate

YYYY

Age

Grade

Allergies/Special Instructions

Child's Name 3

First Name

Last Name

Birthdate

YYYY

Age

Grade

Allergies/Special Instructions

Child's Name 4

First Name

Last Name

Birthdate

YYYY

Age

Grade

Allergies/Special Instructions

Photography

*We use images from our services and events on our website and in various publications. No identifying information is included with these images. If your child’s image cannot be included, please let us know in the Special Instructions area provided for each child.

YAKIMA FOURsQUARE CHURCH

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