Our Redeemer Sunday School Registration

NOTE: Please fill out 1 form for each child. Thank you!
Email address *
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Child's First Name *
Your answer
Child's Last Name *
Your answer
Grade Coming Up *
Date Of Birth *
MM
/
DD
/
YYYY
Date Of Baptism *
MM
/
DD
/
YYYY
Who, other than yourself, may pick up your child? (No child will be released to anyone that we do not know!) *
Your answer
Who may NOT pick up your child?
Your answer
Secondary Emergency Contact Person, relationship to student and phone number *
Your answer
Food Allergies, please list and explain or "none" *
Your answer
Other Allergies/Medical Concerns, please list and explain or "none" *
Your answer
List any medications that child is currently taking or "none" *
Your answer
Do we have your permission to administer primary first aid? (band aids, peroxide, calamine lotion, sun screen, etc.) *
Family Doctor Name *
Your answer
Family Doctor Phone *
Your answer
Fears, special concerns, disabilities or "none". *
Your answer
A copy of your responses will be emailed to the address you provided.
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