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List each child's name; first and last, their age Birth date and last grade attended. Please use a different line fore each child attending.
Guardian's Name *
Guardian's Name
Address *
Address
Mailing Address if different
Mailing Address if different
Main Phone *
Main Phone
Alternate Phone *
Alternate Phone
Medical information we need to know (please include any allergies)
Emergency Contact 1 *
Emergency Contact 1
Emergency Contact Number 1 *
Emergency Contact Number 1
Emergency Contact 2 *
Emergency Contact 2
Emergency Contact Number 2 *
Emergency Contact Number 2
Who may pick up your child?
Do You Attend Church?
May we have permission to Photograph your child? *
May we have permission to use your child's photograph in church publications for the purpose of promotion?
Additional information or anything else you might like us to know about.