Child/Youth Faith Formation Registration 2021-2022
Registration for Faith Formation at Lakewood Congregational Church (United Church of Christ), 1375 West Clifton Blvd., Lakewood, Ohio 44107
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Child's First and Last Name *
Child's Pronouns *
Required
Best email addresses for communication from the church. (You may list more than one) *
Address *
City *
State *
Zip Code *
Child's Birth Date *
MM
/
DD
/
YYYY
Grade/LCC Class (2021/2022): *
For children/youth in Preschool-5th grade, please choose your release option. (for in-person events)
Clear selection
For children being picked up in the nursery or classroom, please list adults/youth (6th-12th grade) permitted to pick child up.
Please list if your child has allergies.
Please list any accommodations we can make to help your child have a positive experience.
Please list anything additional that you'd like us to know about your child or family.
Adult #1 (first and last name) *
Adult #1 Cell Phone Number *
Adult #1 Relation to Child *
Adult #2 (first and last name - N/A if does not apply) *
Adult #2 Cell Phone Number
Adult #2 Relation to Child
I give Lakewood Congregational Church permission to photograph my child/youth. Photos could be used within church and through church publications, printed and digital. *
Parent/Guardian Signature: by typing your name below, you agree that all information in this form is correct and that you give permission for the child/youth listed to participate in Faith Formation/Children & Youth activities through Lakewood Congregational Church. *
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