Child Information (complete one entry per child please)
Child's Name:
Child's Birth Date:
Parent/Guardian Name:
Address:
City: State: Zip:
Best Phone:
Into which grade/age level should the student be placed? Choose One Preschool 3 Preschool 4 Kindergarten First Second Third Fourth Fifth Sixth Seventh Eighth
If preschool has he/she been in a preschool? yes no
Please describe any allergies/medications/special needs the child may have that we should be aware of:
Is your child a "wanderer?" yes no
Emergency contact name: Emergency contact number:
We value your help!
Name of parents/older siblings who would like to help in Sunday School:
Type of help:
Teacher/Co-Teacher Weekly classroom helper Substitute teacher or helper Help with crafts (4 times) Assist the co-superintendents twice a month Assist the co-superintendents for Special Sundays (5 times/year) Actor/actress for skits (up to two times per year)
T-shirt size (check one): choose one youth xs youth sm youth med youth lg adult xs adult sm adult med adult lg