Children & Youth Christian Education Registration Form

Children & Youth Christian Education Registration Form
Salem United Church of Christ

217 Salem Drive, Plymouth, WI 53073 ● (920) 892-7456 ● churchoffice@salemuccplywi.org
4K-6th grades

Sunday School
Parent/Guardian Information:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Email
example@example.com
Student Information:
Name

First NameLast Name
Sex
Date of Birth:

MonthDayYear
Date
Grade
I would like to volunteer:

I am interested in helping, please call me with opportunities as they arise.I am interested in being a substitute teacher.I am interested in serving on our church's Faith Formation Team.
In case of Emergency:

Please list an emergency contact if a parent cannot be reached in worship or at home:
Name

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to child:
Does your child have any allergies that teachers/staff need to be aware of?
If yes, please describe:
Does your child take any medications that teachers/staff need to be aware of?
If yes, please describe:
Are there any special conditions teachers/staff need to be aware of:
If yes, please describe:
While I understand that every reasonable precaution will be taken, in the event of an emergency I authorize any of the Sunday School volunteers to get emergency help for my son/daughter as is deemed appropriate.

I understand that every attempt will be made to contact me in case of an emergency.

I understand that my child may be photographed during his/her Christian Education classes and those photographs may be used for promotional materials for the church. Your child’s name will not accompany any photographs online.
Signature

Clear
MonthDayYear
Date
Should be Empty:

Children & Youth Christian Education Registration Form

Parent/Guardian Information:

Student Information:

In case of Emergency: