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Child Information
Child's First Name
Child's Last Name
Child's Last Completed Grade/Age group
Under 2 Years
2-3 Years Old
4 Years Old & 4K
5K - 2nd Grade
3rd - 5th Grade
6th Grade and Above
Known Allergies
Parent/Guardian Information
Parent/Guardian First Name
Parent/Guardian Last Name
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Phone Number
Emergency Contact
Emergency Contact Name
Emergency Contact Phone Number
Dismissal
Who may pick your child up at dismissal?
Additional Information
Do we have permission to photograph your child?
Yes
No
Do we have permission to use your child's photograph for the purpose of promotion?
Yes
No
Does your child attend church? If Yes, Where?
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