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List each child's name; first and last, their age Birth date and The grade they will be attending in the fall. Please use a different line for each child attending. EXAMPLE : John Doe, 9, 12/5/09, 4th, boys 11/12 Jane Doe, 10, 11/15/08, 5th, girls 8/9
Guardian's Name *
Guardian's Name
I Want to Help
Sign me up as a volunteer! (A CCE ministry application must be completed and backround checks are performed. We Love Our Kids!)
Address *
Address
Main Phone *
Main Phone
Alternate Phone *
Alternate Phone
Medical information we need to know (please include any allergies) Please list the name of your child and their condition. EXAMPLE: Mary has a nut allergy. John has epilepsy
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? *