St. Andrew's 2018–2019 Program Registration for Children & Youth
Please use this form to register your children for Kids' Place, church school, Rite-13, confirmation preparation, and/or high school youth group at St. Andrew's Church.
Family Information
Parent name(s) *
Your answer
Is this your first year at St. Andrew's, OR have your family's address, phone number(s), or email address(es) changed within the past year? *
If yes, please provide your updated contact information.
Your answer
Child 1
First name *
Your answer
Last name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Gender *
School (in 2018–2019)
Your answer
Grade level (in 2018–2019) *
Child 2
First name
Your answer
Last name
Your answer
Date of birth
MM
/
DD
/
YYYY
Gender
School (in 2018–2019)
Your answer
Grade level (in 2018–2019)
Child 3
First name
Your answer
Last name
Your answer
Date of birth
MM
/
DD
/
YYYY
Gender
School (in 2018–2019)
Your answer
Grade level (in 2018–2019)
Child 4
First name
Your answer
Last name
Your answer
Date of birth
MM
/
DD
/
YYYY
Gender
School (in 2018–2019)
Your answer
Grade level (in 2018–2019)
Getting Involved
My child(ren) might be interested in ...
I (or my spouse) might be interested in ...
Comments:
Your answer
Medical & Dietary Information
Do any of your children carry a rescue inhaler or Epi-Pen? *
If so, which child and for what purpose?
Your answer
Do any of your children have food allergies or dietary restrictions? If yes, please indicate:
Your answer
Do any of your children have other severe allergies? If yes, please indicate:
Your answer
Do any of your children have behavioral, emotional, or learning concerns that call for accommodations in church programs? If yes, please indicate:
Your answer
Has your family experienced any recent major events, such as a divorce, death, serious illness, move, or school change? If yes, please indicate:
Your answer
Is there any other information that will help St. Andrew's better serve your child?
Your answer
Health insurance provider & policy number (optional)
Your answer
Consent to medical treatment *
Required
Program Fees
Please check one of the following options. All checks can be made payable to St. Andrew's Church and delivered to Susan Jackson, Christian Learning Coordinator. *
Required
Photo Release
By enrolling your child(ren) in programming at St. Andrew's, you agree to allow your children to be photographed or videotaped at church events, to allow images of your children to be used in church communications (both print and Web), and to release St. Andrew's from any liability, damages, or claims that might arise from such use. We ask permission before prominently featuring photos of individuals on our Web site, and do not identify anyone by name on Web site photos. *
Required
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