Church school registration

Family's Last Name (or Names)*

Parent/Guardian Name 1*

Address

Street Address City State ZIP Code

Mobile*

Preferred Email*

Talents/Hobbies/Skills to Share

Parent/Guardian Name 2

Address

Street Address City State ZIP Code

Mobile

Preferred Email

Talents/Hobbies/Skills to Share

Child Name 1*

Date of Birth*

Grade Level in Fall 2020*

Mobile

Preferred Email

Child Name 2

Date of Birth

Grade Level in Fall 2020

Mobile

Preferred Email

Child Name 3

Date of Birth

Grade Level in Fall 2020

Mobile

Preferred Email

Child Name 4

Date of Birth

Grade Level in Fall 2020

Mobile

Preferred Email

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

Yes.
No.

Please provide important information.

Photo Release*

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.

Last names of children will not be used in any publication.

Permissions*

I authorize delivery of program materials.

Yes
No

Times delivery may be made*

Select all time slots that work for you.

Noon - 5 p.m. on Tuesday September 8th
9 a.m.-Noon on Wednesday, September 9th
Noon-5 p.m. on Wednesday, September 9th
9 a.m.-Noon on Thursday, September 10th
Noon-5 p.m. on Thursday, September 10th
6 p.m.-9 p.m. on Thursday, September 10th

Delivery Date that

Special Delivery Instructions

Emergency contact name*

Relationship to Child*

Mobile*

Would you like to receive the weekly Church School News email?

Yes.
No.

What email address(es) would you like the Church School News email sent to?

Would you like to receive church-wide email communications?

Yes.
No.

What email address(es) would you like church-wide communications sent to?

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