Church School Registration Form 2021-2022
Please fill out one form per child.
Date Registration Form Completed:
*
/
Month
/
Day
Year
Date
Parent/Guardian Information
Parent/Guardian First/Last Name:
*
Relationship to Child:
*
Parent/Guardian E mail:
*
example@example.com
Parent/Guardian Home Address
*
Street Address
Street Address Line 2
Town/City
State / Province
Postal / Zip Code
Zip code:
*
Parent/Guardian Home phone:
*
Parent/Guardian Cell:
*
[PHOTO RELEASE FOR MINORS UNDER 18] Wilton Presbyterian Church, St. Matthews Episcopal Church and WEPCO have my permission to use my or my child's photograph publicly to promote their ministry. I understand that the images may be used in print publications, online publications, presentations, websites and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Please Sign Above
Child/Youth Information
Child's First Name
*
Child's Last Name
*
Child's Nickname:
*
Child's Date of birth:
*
/
Month
/
Day
Year
Date
Current Age:
*
Gender:
School attending:
*
Grade in Fall 2021:
*
Allergies and food restrictions:
*
Any learning or social challenges we should be aware of:
This child learns best by:
Hobbies and interests:
Submit
Should be Empty: