Sunday School Registration
Child's Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
Home Phone Number *
Your answer
E-mail Address (parent) *
Your answer
Child's Grade Level as of 9-1-18 *
(Preschool, 1st, etc)
Alternate Emergency Contact *
Name
Your answer
Relationship to Child *
(ie parent, grandparent, friend, etc)
Your answer
Alternate Emergency Contact Phone *
Your answer
Are there any family situations we need to be aware of?
ie Custodial issues, other matters, etc)
Your answer
Please let us know if you approve of the following for your child...
(only check those that you approve of)
Confidential Medical Report *
The information below is requested in case of any illness or accident. Please check if your child suffers from any of the following
Required
Allergies *
Is your child allergic to
Required
Please list any physical or special needs:
(ie dietary requirements, etc)
Your answer
I authorize the leader(s) in charge of the above mentioned group where it is impractical to communicate with me, to arrange for my child to receive such medical or surgical treatment as the leader(s) may deem necessary at any time during the activities of Saint Matthew's Lutheran Church. I further authorize the use of ambulance and/or anesthetic by a qualified medical practitioner if in his/her judgement it is necessary. I accept responsibility for payment of all expenses associated with such treatment. I appreciate that every care will be taken by the leaders and recognize that those connected with that group cannot be held responsible for personal injury, loss, or theft of property affecting my child. *
My entering my name below is my electronic signature that all the above information is accurate to the best of my knowledge.
Your answer
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