Form
Child #1 Name
First Name
Last Name
Child #1 Grade (entering)
Child #2 Name
First Name
Last Name
Child #2 Grade (entering)
Child #3 Name
First Name
Last Name
Child #3 Grade (entering)
Child #4 Grade (entering)
Child #4 Name
First Name
Last Name
Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Home Church
Allergies, Medical Conditions, or Special Needs? Please note which child(ren)
I give First Presbyterian Church permission to post pictures of my child(ren) on social media, the First Presbyterian Church of Mattoon Webpage, and on Sunday Morning Worship Services.
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Should be Empty: