NEXTGEN: New Family Form

Thanks for checking out our NextGen program! Here at Piedmont Community Church NextGen, we love to partner with parents to help their kids develop a faith that sticks. In order to provide you with ongoing resources for your family, simply fill out this form. We can't wait to hear from you!

Your name *

Email address *

Phone number *

Address *

Household members

Household Medical Notes

Please tell us of any other medical conditions of which we should be aware.

EMERGENCY CONTACT

Let us know who to contact in case of an emergency during NextGen or other church events/activities.

Emergency Contact: FIRST & LAST NAME

Please provide both first and last name for your Emergency Contact.

Emergency Contact: PHONE

Please provide the best primary telephone number for your designated emergency contact.

Emergency Contact: RELATIONSHIP

AUTHORIZED TO PICK UP CHILD/CHILDREN

Please tell us who in and outside of your household is authorized to pick up your child or children from Piedmont Community Church programs/activities.

AUTHORIZED PERSON #1

Authorized Person #1: FIRST NAME

Authorized Person #1: LAST NAME

Authorized Person #1: PHONE

Authorized Person #1: RELATIONSHIP TO FAMILY

AUTHORIZED PERSON #2

Authorized Person #2: FIRST NAME

Authorized Person #2: LAST NAME

Authorized Person #2: PHONE

Authorized Person #2: RELATIONSHIP TO FAMILY

AUTHORIZED PERSON #3

Authorized Person #3: FIRST NAME

Authorized Person #3: LAST NAME

Authorized Person #3: PHONE

Authorized Person #3: RELATIONSHIP TO FAMILY

ANY ADDITIONAL INFORMATON?

Child/Children Information *

Please provide any additional information for each child listed above.

How did you learn about NextGen?

Social Media (Instagram, Facebook, and Youtube)

Family, Friends, or Neighbors

A NextGen Event (Fall Fest, Snow Day, etc.)

Sunday Service

The Messenger

Other

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