Bible Fellowship Group Information Sheet – Precious Jewels

Child's Name*

Address*

Home Phone*

Birthday*

Age*

Allergies

Toilet Trained: YesNo

Seizures (type, frequency, etc.)

Medications (name, side effects, when last taken, etc.)

Menstrual Cycle

Preferences

Likes:

Dislikes:

Please describe any additional health concerns and/or physical behaviors the leaders need to be aware of: (biting, running, pinching, etc.)

Father's Name*

Father's Cell:

Father's Email:

Mother's Name*

Mother's Cell:

Mother's Email:

Parent's Location During 11:00 Service: