Childcare

Responsible Adult

Fields marked with an * are required

Let our childcare workers know important info about your child if you plan to attend.

**NOTE: North Coast has many events happening at all campuses. It is important that you fill out all the fields that show up as you select your campus and event. Otherwise we will not be able to match your child's reservation to your campus event.

Parent/Guardian Name *

Address

City

Zip Code

Email *

Parent's Cell Phone *

Alternate Phone

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone: *

Child 1

Fields marked with an * are required

1. Child's First Name *

1. Child's Last Name *

1. Child's Date of Birth *

1. Child's Gender *

Male
Female

1. Health/Allergies?

1. Special Needs?

Child 2

2. Child's First Name

2. Child's Last Name

2. Date of Birth

2. Gender

Male
Female

2. Health/Allergies?

2. Special Needs?

Child 3

3. Child's First Name

3. Child's Last Name

3. Date of Birth

3. Gender

Male
Female

3. Allergies/Health?

3. Special Needs

Child 4

4. Child's First Name

4. Child's Last Name

4. Date of Birth

4. Gender

Male
Female

4. Health/Allergies?

4. Special Needs?

Child 5

5. Child's First Name

5. Child's Last Name

5. Date of Birth

5. Gender

Male
Female

5. Health/Allergies?

5. Special Needs?

Additional Info

Anything else we should know?

Adult Ministries

Children

Student Ministries

Other Ministries