Church school registration

Family Name*

Preferred Email*

Parent/Guardian Name 1*

Mobile*

Talents/Hobbies/Skills to Share

Parent Guardian Name 2

Address

Street Address City ZIP / Postal Code

Mobile

Talents/Hobbies/Skills to Share

Child Name 1*

Date of Birth*

Grade Level*

Child Name 2

Date of Birth

Grade Level

Child Name 3

Date of Birth

Grade Level

Child Name 4

Date of Birth

Grade Level

Any medical dietary or family info that the Teacher should know?*

Which?

I give permission to allow pictures and videos of my child to appear in publications and/or on our website.
I do not give permission for pictures or videos of my child to appear in publications or on the website.

Emergency contact name*

Relationship to Child*

Mobile*

Church School Registration