Sunday School Registration

Parent/Guardian Information

Parent/Guardian Name: *

Address: *

City: *

Zip Code: *

Home Phone:

Cell Phone:

Email: *

Parent/Guardian Name:

Address:

City:

Zip Code:

Home Phone:

Cell Phone:

Email:

Child(ren) Information

Name: *

Grade (2016-2017): *

Date of Birth: *

Name:

Grade (2016-2017):

Date of Birth

Name:

Grade (2016-2017):

Date of Birth

Name:

Grade (2016-2017):

Date of Birth

Siblings under 3 years old (include name and DOB):

Emergency and Medical Information

In case of emergency, if a parent/guardian cannot be reached, please contact:

Name: *

Phone: *

Allergies / Medical Concerns / Learning Differences / Special Considerations:

In the unlikely event of an emergency, if I cannot be contacted, I give permission to Living Waters adult leadership to seek proper medical care. *

I accept

I understand that photographs and videos of my child may be taken during church programming, and I give permission for those videos/photos to be used for promotional or other purposes. *

I accept

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