2025 Christian Formation Registration Form

Christian Formation Registration Form

Sunday School begins 8/24/2025
Participant Information
Participant (Child/Youth) Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Participant Email (optional)
example@example.com
Participant Phone Number (optional)
Please enter a valid phone number.Format: (000) 000-0000.
School*
Grade*
Youth Participants: Anticipated Junior or High School Graduation Year
Parent Information/Emergency Contacts
Parent/Guardian Name #1*

First NameLast Name
Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
I want to receive Family E-Notes
Parent/Guardian Name #2

First NameLast Name
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
I want to receive Family E-Notes
Alternate Emergency Contact (if a parent cannot be reached) *

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Health & Insurance Information
Name of Physician/Pediatrician*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Insurance Company
Insurance Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Member/Group ID:
If you have no insurance, please fill out who is responsible for payment of medical expenses.
Person responsible for payment & Relationship
Any Allergies or Medical Conditions?*

YesNo
Please give details including allergies, ongoing medications, and any conditions to which a physician should be alerted, or type "N/A":*
Please list any other significant situations (personal, family, health, etc.) that we should be aware of concerning your child/youth:

Christian Formation Registration Form

Participant Information

Parent Information/Emergency Contacts

Health & Insurance Information

Additional Information