Child's First Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Name(s) of Parents(s)/Guardian(s) *

First Name

Last Name

Cell Phone *

(###)

###

####

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Permission: *

May we send you weekly email updates and announcements?

Yes

No

Photo Permission: *

Please check the box if you give permission for your child's photograph/name to be used.

Yes, my child’s photo can be taken for a Church School Directory/Yearbook.

Yes, my child’s photo may be shown on the church website. (Please note the photo will not be identified with your child’s name online.)

Allergies *

Does your child have any allergies/health conditions that we should be aware of?

Yes

No

Christmas Pageant *

The Christmas Eve pageant will be on Tuesday December 24 in the early evening.

My child is interested in participating in the pageant this year

My child is not interested or able to participate in the pageant this year.

We are undecided at this time.

Volunteering *

Please check all of the ways that you would like to volunteer as parent/guardian

Sunday School (teaching or assisting)

Nursery (assisting care-provider with 0-2 year olds)

Youth group (monthly events for older children)

PA Day Camp

Christmas Pageant

Other (please specify below)

Your Name *

First Name

Last Name