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Church School Registration 2017
Child's first name (nickname in parentheses) *
Your answer
Untitled Title
Child's last name *
Your answer
Child's date of birth *
MM
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DD
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YYYY
Child's grade (fall 2017) *
Your answer
Child's school *
Your answer
Child #2's first name (nickname in parentheses)
If you would like to register multiple children under the same household please fill out this small portion for each additional child. A single online registration form can register up to three children.
Your answer
Child #2's last name
Your answer
Child #2's date of birth
MM
/
DD
/
YYYY
Child #2's grade (fall 2017)
Your answer
Child #2's school
Your answer
Child #3's first name (nickname in parentheses)
Your answer
Child #3's last name
Your answer
Child #3's date of birth
MM
/
DD
/
YYYY
Child #3's grade (fall 2017)
Your answer
Child #3's school
Your answer
Parent/Guardian first name *
(This parent/guardian is the first person we would contact in an emergency.)
Your answer
Cell phone (or primary contact phone) *
Your answer
Can we text you at this number? *
Relationship to child *
Email address: *
(where you would like to be updated about activities, receive special events notices, etc.)
Your answer
Mailing Address *
Your answer
Are you a member of St. Pauls? *
Parent/Guardian (spouse/partner, 2nd legal guardian) first + last name: *
(This parent/guardian is the second person we would contact in an emergency)
Your answer
Relationship to child: *
Your answer
Parent/Guardian (spouse/partner, 2nd legal guardian) cell phone or secondary contact phone:
Your answer
Email address of 2nd parent/guardian:
Your answer
Mailing address (if different from first address):
Your answer
Does your child have an email address or cell phone number? If so, please include here:
Your answer
I give my permission for St. Pauls to use unidentified photos of my child in print materials, on the SPUCC website, and on social media. *
PARENT/GUARDIAN RELEASE: *
By checking the box below, I give my consent for my child to participate in St. Pauls UCC activities. I understand that St. Pauls will not be held responsible for any accidents or injuries that occur at the church. I agree to hold harmless any St. Pauls staff, church school teachers, and youth group leaders. In the event that my child experiences a medical emergency during church school or at a church activity, I authorize St. Pauls, its staff, the church school teachers, and youth group leaders to care for my child on my behalf. These individuals may authorize all necessary medical care in my absence.
Are you interested in receiving information about any of the following activities for children and youth at St. Pauls?
Check all that apply.
Please list any allergies or special needs your child has that we should be aware of:
Your answer
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