CHURCH SCHOOL REGISTRATION FORM 2021

First Congregational Church in Winchester

21 Church Street Winchester MA 01890

(781)729-9180
CHURCH SCHOOL REGISTRATION FORM

For children in kindergarten through fifth grade
For infants and toddlers, please complete a separate Nursery Registration form. For youth (middle school and high school students), please complete a Youth Information Form. A separate form for each child must be filled out.
Child's Name

First Name Last Name
Goes by
Child's Date of Birth:

Month Day Year
Date
Child's Gender:
Name of School Attending:
HS Graduation Year:
Parent/Guardian's Email:
example@example.com
Parent/Guardian's Name:
Cell Phone #:
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency contact name and cell phone number in case a parent cannot be reached:
Name and telephone number of Child's doctor:
Health Insurance Company Name:
Health Insurance Policy Number:
Please list your child's special learning needs of which we should be aware:
Please list your child's allergies, physical limitations, and health concerns of which we should be aware:
In order to share the good news of the ministries of the church, we sometimes take photos of children and youth for use on bulletin boards, in our newsletters and on our website. When published on our website we do not include any identifying information (name, address, etc.) about the child along with the photo. Do you authorize the use and reproduction of your child(ren)'s photo(s) by the church?
Please share any additional information you would like:
Please indicate where you would like to help out:

Teaching Sunday School Assisting Sunday School teachers Being a substitute teacher Chaperoning on trips Planning events and activities Planning food for events Helping with administrative tasks Driving to various events Leading music with the children
I understand that every effort will be made to contact parents/guardians in the event of an emergency. In an emergency requiring medical care and treatment, I authorize any physician, hospital or other healthcare provider to give care to this minor. I also give permission for the transport of my child to/from a doctor and/or hospital by a chaperone or ambulance.
Parent's/Guardian's signature:

Clear
Date:

Month Day Year
Date
Should be Empty: