Sunday School/Nursery Registration Form

Greensburg Church of God Child Registration Form

Pre-Register; VBS, JR. Church, Nursery
Child Information
How many children are you registering?*
Please register all of your children, ages birth through grade 8 on this form.
First Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade *
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GCOD my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Greensburg Church Of God from liability in acting on my behalf in this regard. *
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Second Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade*
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GCOG my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Greensburg Church of God from liability in acting on my behalf in this regard. *
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Third Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade *
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GCOG my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Greensburg Church of God from liability in acting on my behalf in this regard. *
Type in initials above.
Special Concerns:In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Fourth Child
Child's Name*

First NameLast Name
Child's Birth Date*

MonthDayYear
Current Grade *
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give GCOG my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release Greensburg Church of God from liability in acting on my behalf in this regard. *
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Parent/Guardian Contact Information
Parent/Legal Guardian Name 1*

First NameLast Name
Contact Phone Number 1*
Contact Email 1*
example@example.com
Contact Address 1*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the address above the same as the child(ren).*

YesNo
Parent/Legal Guardian Name 2

First NameLast Name
Contact Email 2
example@example.com
Contact Phone Number 2
Contact Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the address above the same as the child(ren).

YesNo
Are there any persons to which the child (children) may NOT be released to?*

YesNo
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)*

First NameLast Name
Emergency Contact 1 Phone Number*
Relationship to child(ren)
Emergency Contact 2 (other than parent/guardian listed above)

First NameLast Name
Emergency Contact 2 Phone Number
Relationship to child(ren)
Media Release

In order to share the good news of the mission and ministry of Greensburg Church of God, we occasionally use images (photo/video) of students in classrooms or during special programs, or sent to GCOD by parents/guardians. These images may be shared on church bulletin boards, newsletters, in local newspapers or other printed materials, on our website, social media (email communications, live-stream events, Facebook, Instagram, YouTube, etc.), or in presentations during worship. If you are comfortable with the use of your child(ren)’s and/or youth(s)’s images for these purposes, please indicate below.
I hereby give permission for Greensburg Church of God to take and use images of my child(ren)/youth (photo or video) taken during church-related activities, or shared by me with GCOD staff, for church purposes only as described above. No children/youth will be identified by name. I understand that I will be contacted for special permission should any photo be considered for use other than described above.*

I AgreeI Disagree
Parent/Guardian Covenant

I understand that many volunteer hands are needed. I covenant to use my gifts in some way this program year to support the Church School & Nursery of GCOD. As a partner in this ministry, I pledge to uphold and support my child’s involvement in all aspects of participation including supporting the Church School teachers in their efforts to teach this year.
Choose all that apply. I am interested in:

Church School teacherClassroom helperServing on the Board of Christian Education
Should be Empty:

Greensburg Church of God Child Registration Form

Child Information

First Child

Second Child

Third Child

Fourth Child

Parent/Guardian Contact Information

Media Release

Parent/Guardian Covenant