CCEP 2022 - 2023 (Children's Christian Education Program) Student Registration Form

CCEP (Children's Christian Education Program) Student Registration Form

Thank you for updating and/or filling out our registration form. Please do not come to class if your child is not feeling well, displaying signs of a fever higher than 99.5 degrees, or has been in close contact with someone with Covid-19 with in the past 2 weeks. Please let us know how we can serve your families' spiritual needs in any way and if there are any questions or requests you'd like to ask of us in the additional comments section at the end of your registration form.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Name 1

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/ Guardian Name 2

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Information

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Additional Comments
My child (child 1) has the following medical conditions you should be aware of blanks . Please follow these instructions to address above mentioned medical condition: 2. If a parent/guardian cannot be reached, I consent to emergency medical care being given to my child by a trained staff member or medical professional. Signature (Please Sign Below):
My child (child 2) has the following medical conditions you should be aware of blanks . Please follow these instructions to address above mentioned medical condition: 2. If a parent/guardian cannot be reached, I consent to emergency medical care being given to my child by a trained staff member or medical professional. Signature (Please Sign Below):
Signature

Clear
Should be Empty:

CCEP (Children's Christian Education Program) Student Registration Form