2024 REGISTRATION FOR INFANTS - 5th GRADE

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CHILD'S NAME

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AGE

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Birthday

*

SEX

*

Please select one option.

Male Female

GRADE

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Please select all that apply.

Infant (birth-24 months) Toddler (2 years) Preschool PRE-Kindergarten Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade

School District

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ADDRESS

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MEDICAL CONDITIONS, KNOWN ALLERGIES & CURRENT MEDICATIONS

Parent/Guardian #1 First and Last Name

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Parent/Guardian #1 PHONE Please mark (Home or Cell)

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Parent/ Guardian #1 EMAIL

This address will receive a confirmation email

Parent/Guardian #2 First and Last Name

*

Parent/Guardian #2 PHONE (Please mark Home or Cell)

Parent/Guardian #2 EMAIL

PARENTAL SUPPORT

Please select all that apply.

Small Group Leader for Sunday School Nursery/Toddler Care during Worship Service Substitute Teach Vacation Bible School (June 2022) Teach during the summer months Serve on Family Ministries Help with Decorations / Event Set Up Sunday Greeters/ Check-In

ADULT/S ON PREMISE (If other than Parents) and contact info (phone, address, email

*

Description

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