Child's Full Name:

Name Child Prefers to Use:

Female

Male

Date of Birth:

School Grade*:

*Children enroll in the same grade they will attend in public school for the 2011-12 school year.

Name of School Attending:

Has your child been baptized: Yes No

If yes, Date of Baptism:

Place of Baptism:

Parents or Guardians' 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:

Please check the areas in which you can help. Thanks for your consideration in being part of this ministry!

Teacher
Greeter
Parent Assistant
Rotation Workshops:
Art Studio	Computer Lab	AV Theater
Mission	Drama	Cooking
Storytelling	Games	Music
Puppets	Other:
Special Events:
Yes, I will help!

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.