Christian Kids! Church School Program Registration Form 2024-2025

Christian Kids! Church School Program for Immanuel & Riverfront 2024-2025

For kids in PreK-8th grade. Please use other form for Youth Group participants 6th-12th grade.
Child #1

First NameLast Name
Birth Date

MonthDayYear
Gender
Grade if applicable
Child #2

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Grade if applicable
Child #3

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Grade if applicable
Child #4

First NameLast Name
Birth date

MonthDayYear
Date
Gender
Grade if applicable
Child #5

First NameLast Name
Birth Date

MonthDayYear
Date
Gender
Grade, if applicable
Mailing Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Parent Name

First NameLast Name
Parent Name

First NameLast Name
Contact email
Main Contact Number

Area CodePhone Number
Allergies?
In order to provide the best church school experience, please use the space below to make us aware of any special needs your child may have. You may speak to Tracy Gormley, Minister of Faith Formation, to discuss any concerns. All information is held in confidence and shared only on a need to know basis.
Special needs/accommodations?
Photo/Video Release
I give permission for my child’s photo to be taken by Church staff or volunteers during activities, with the understanding that pictures might be used in Immanuel Congregational Church publications. Note that Immanuel/Riverfront does not control the taking of photographs by other participants.

YesNo
Signature

Clear
Should be Empty: