FCCS Church School Reg Form 24/25

1

How many children are you registering?* This field is required.Please register all of your children, ages birth through grade 8 on this form.

2

Child's Name* This field is required.

First Name

Last Name

3

Child's Birth Date* This field is required.Enter your child's birthdate below.

4

Current Grade * This field is required.Please select the grade your child is entering in the fall of 2022 from the drop-down box below.

Please choose Nursery (I/T) for children under the age of 3

5

Medical Information: Please list any allergies and/or other health concerns.* This field is required.Type "none" if there are no allergies or health concerns.

6

In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS 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 First Congregational Church of Southington from liability in acting on my behalf in this regard.* This field is required.Type in your initials below.

7

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.Type "none" if there are no special concerns with your child.

8

Child's Name* This field is required.

First Name

Last Name

9

Child's Birth Date* This field is required.Enter your child's birthdate below.

10

Current Grade* This field is required.Please select the grade your child is entering in the fall of 2022 from the drop-down box below.

Please choose Nursery (I/T) for children under the age of 3

11

Medical Information: Please list any allergies and/or other health concerns.* This field is required.Type "none" if there are no allergies or health concerns.

12

In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS 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 First Congregational Church of Southington from liability in acting on my behalf in this regard. * This field is required.Type in your initials below.

Type in initials above.

13

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.Type "none" if there are no special concerns with your child.

14

Child's Name* This field is required.

First Name

Last Name

15

Child's Birth Date* This field is required.Enter your child's birthdate below.

16

Current Grade* This field is required.Please select the grade your child is entering in the fall of 2022 from the drop-down box below.

Please select Nursery (I/T) for children under the age of 3

17

Medical Information: Please list any allergies and/or other health concerns.* This field is required.Type "none" if there are no allergies or health concerns.

18

In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS 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 First Congregational Church of Southington from liability in acting on my behalf in this regard. * This field is required.Type in your initials below.

Type in initials above.

19

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.Type "none" if there are no special concerns with your child.

20

Child's Name* This field is required.

First Name

Last Name

21

Child's Birth Date* This field is required.Enter your child's birthdate below.

22

Current Grade* This field is required.Please select the grade your child is entering in the fall of 2022 from the drop-down box below.

Please select Nursery (I/T) for children under the age of 3

23

Medical Information: Please list any allergies and/or other health concerns.* This field is required.Type "none" if there are no allergies or health concerns.

24

In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS 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 First Congregational Church of Southington from liability in acting on my behalf in this regard. * This field is required.Type in your initials below.

Type in initials above.

25

Special Concerns: 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.Type "none" if there are no special concerns with your child.

26

Parent/Legal Guardian Name 1* This field is required.

First Name

Last Name

27

Contact Phone Number 1* This field is required.

28

Contact Email 1* This field is required.

example@example.com

29

May we add you to our First Congregational Church of Southington weekly All Church Update and Church School email list?* This field is required.Please indicate "yes" or "no". If you indicate "no" and are already on our email list, you will be removed for future digital correspondence.

Yes

No

30

Contact Address 1* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

31

Is the address above the same as the child(ren).* This field is required.

Yes

No

32

Parent/Legal Guardian Name 2

First Name

Last Name

33

Contact Email 2

example@example.com

34

May we add you to our First Congregational Church of Southington weekly All Church Update and Church School email list?Please indicate "yes" or "no". If you indicate "no" and are already on our email list, you will be removed for future digital correspondence.

Yes

No

35

Contact Phone Number 2

36

Contact Address 2

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

37

Is the address above the same as the child(ren).

Yes

No

38

Are there any persons to which the child (children) may NOT be released to?* This field is required.

Yes

No

39

Who may you child (children) NOT be released to?Please note a copy of a protective order may be required to restrict access.

40

Emergency Contact 1 (other than parent/guardian listed above)* This field is required.

First Name

Last Name

41

Emergency Contact 1 Phone Number* This field is required.

42

Relationship to child(ren)

43

Emergency Contact 2 (other than parent/guardian listed above)

First Name

Last Name

44

Emergency Contact 2 Phone Number

45

Relationship to child(ren)

46

I hereby give permission for First Congregational Church of Southington to take and use images of my child(ren)/youth (photo or video) taken during church-related activities, or shared by me with FCCS 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.* This field is required.

I Agree

I Disagree

Please contact me for permission.

47

Choose all that apply. I am interested in:

Church School teacher

Classroom helper

Serving on the Board of Christian Education