First Name:

Last Name:

Address:     

City:               State: 

Zip Code:     

Child's Age:

D.O.B:     

Home Telephone:

Parent/caregiver's cell phone:

Parent's email:

Grade in School:

Allergies or other medical conditions: Yes No

If Yes, please list what they are:

Has your child been baptized: Yes     No

Has your childreceived a Bible from our church?  Yes No

In Case of Emergency Contact:

Phone:

Are you willing to help teach/shepherd in our Sunday School rotation schedule occasionally?   Yes

If so what ages? Check all that apply

Pre-k/k   1st -2nd   3rd-4th    5th-6th   Jr. High  Sr. High