Church School Registration Form 2018-2019
First Church of Christ, 680 Hopmeadow Street, Simsbury, CT 06070
Phone (860-651-3593), web site www.fccsimsbury,org (main website) &
www.firstchurchsimbury.com (children’s ministries website)
Email address *
Be Sure to Fill Out This Form in its Entirety and Click SUBMIT at the End.
You will receive an emailed confirmation once form is submitted.
Parent / Guardian Information
Last Name *
Your answer
Address *
Your answer
Parent / Guardian Name *
Your answer
Address (if different from Child)
Your answer
Parent / Guardian Name
Your answer
Address (if different from Child)
Your answer
Children Live With: *
Your answer
Additional Parent / Guardian Name:
Your answer
Primary Phone *
Your answer
Secondary Phone
Your answer
Children's Information
List all children through High School:
• Confirmation students (8th grade) will receive a letter about the Confirmation class.
• Information for Junior High and High School students will be given to the youth minister.
Child's Name #1: *
Your answer
Nickname:
Your answer
Sex: *
Date of Birth: *
MM
/
DD
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YYYY
Grade / Class: *
Your answer
Any Allergies, Medical Conditions, Learning Disabilities, Behavior Issues, Gifts or Talents, etc we should know about your child:
Your answer
Child's Name #2:
Your answer
Nickname:
Your answer
Sex:
Date of Birth:
MM
/
DD
/
YYYY
Grade / Class:
Your answer
Any Allergies, Medical Conditions, Learning Disabilities, Behavior Issues, Gifts or Talents, etc we should know about your child:
Your answer
Child's Name #3:
Your answer
Nickname:
Your answer
Sex:
Date of Birth:
MM
/
DD
/
YYYY
Grade / Class:
Your answer
Any Allergies, Medical Conditions, Learning Disabilities, Behavior Issues, Gifts or Talents, etc we should know about your child:
Your answer
Child's Name #4:
Your answer
Nickname:
Your answer
Sex:
Date of Birth:
MM
/
DD
/
YYYY
Grade / Class:
Your answer
Any Allergies, Medical Conditions, Learning Disabilities, Behavior Issues, Gifts or Talents, etc we should know about your child:
Your answer
Authorizations
Do you grant us permission to use photos of your child in church publications, bulletin boards, website, Facebook, etc.? *
Do you grant us permission to use videos of your child in church’s website, Facebook, classroom, events, etc.? *
Emergency Authorization: In the event of a medical emergency you have my permission to call 911 for help and to attempt to locate an M.D. in church. I understand you will locate and notify me immediately. If I will not be on the church premises, I understand that I must tell my child’s teacher where and how I can be located, in case of an emergency. *
While my child is in class, I can be located in: *
Parent or Guardian Signature - by initialing below I authorize the above information is correct and true to the best of my knowledge. *
Your answer
I am interested:
Our children’s ministry programs are made possible by its volunteers. We need you! We also recognize that each person has a different set of gifts, skills, and interests. Can we help you find the right fit for you? Please check off your areas of interest:
A copy of your responses will be emailed to the address you provided.
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