Child's Full Name:

Name Child Prefers to Use:

Female	Male	Date of Birth:
		Attending Preschool?: Yes No

Name of School, if attending preschool:

Has your child been baptized: Yes No

If yes, Date of Baptism:

Place of Baptism:

Parents or Gardians' Names:

Street Address:

City, State, Zip:

Home Phone:

Work Phone:

Cell Phone:

Fax:

Email:

Person to contact in emergency if parents/guardians not available. Please provide name, address and phone:

Comments or special information regarding activity, medical or diet restrictions:

Where will you be during the Sunday Education hour?

Volunteer Opportunities:

To support this class, we are asking all parents to assist three Sundays out of the 2007-08 school year. This assistance will provide help to the storyteller/teacher to manage the class and will provide the needed two adults per class of children required by the Child Protection Policy followed at Lewinsville Presbyterian Church.

I will be able to assist in this class on these days (please check at least 3 days from the following list):

September	9	16	23	30
October	7	14	21	28
November	4	11	18	25
December	2	9	16	23
January	6	13	20	27
February	3	10	17	24
March	2	9	16	30
April	6	13	20	27
May	4	11	18	25
June	1	8	15

You will be asked to sign the following medical release before leaving your child in Church School:

EMERGENCY MEDICAL RELEASE: In case of a medical emergency, I give my permission for emergency medical care to be administered to my child until I can be reached for expressed permission.