Today's Date (MM/DD/YY)

   Name of Mother   Cell#
   Name of Father    Cell#

   Other persons authorized to pick up child:
 

   Child's Age      Child's DOB (MM/DD/YY)   Male  Female
   Child's Grade (This Fall they will attend)  (K-8th)

   My Child is not old enough to attend Sunday School so . . .
         He/She will attend nursery (birth-age 2)  

         He/She will attend Toddler Room (3, 4, Pre-K)
 

   Any Allergies/Medical Needs?  

   Special Needs?

  
   Do we have permission to photograph your child for use in our church
   newsletter, website, and other advertising materials?  YES NO 

   I am registering my child for (check all that apply):

   (check all that apply)

   9:00 Sunday School

   10:30 Growing Hour

   Wednesday Kid's Classes

    I will support my child's Christian Education by occasionally serving as a:

   Teacher        Teacher's Assistant       Behind the Scenes Helper

    Parent/Guardian Name