Fall Sprouts Registration
Registration for 2018 - 2019 church year. Move up date is August 19, 2018.
Email address *
Mailing Address *
Your answer
Child's Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Grade for 2018-2019
Name Child Prefers to be called *
Your answer
Any known allergies? *
If previous answer is yes, what are the allergies and what treatment should be administered in case of an allergic reaction?
Your answer
Any medical condition? *
If previous answer is yes, what is the medical condition and what is the treatment in case of an issue?
Your answer
Parent/Guardian Name & Cell Number *
Your answer
Additional Parent/Guardian Name & Cell Number
Your answer
Emergency Number if previous numbers are unavailable.
Your answer
Please list names of who can pick up your child: *
Your answer
Are there any custody issues? *
If previous answer is yes please indicate that you will see the Children's director with any specific instructions.
Which Worship Service do you attend? *
Can we post this child's picture on social media with church related posts? *
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