Elementary Registration 2017-18
Household Information
Parent/Guardian 1
First and Last name *
Your answer
Relation to Child(ren) *
Your answer
Phone Number *
Your answer
Phone Type *
Email Address *
Your answer
Home address *
Your answer
Parent/Guardian 2 (If applicable)
First and Last Name
Your answer
Relation to Child(ren)
Your answer
Phone Number
Your answer
Email Address
Your answer
Other safe adults who are authorized to pick up your child(ren). If none, enter "none." *
Your answer
Child Information
Child 1
Name of Child *
Your answer
Birthdate of Child *
MM
/
DD
/
YYYY
Grade for 2017-2018 School Year *
School Attending *
Your answer
Please list any allergies, medical conditions, or learning differences, as well as how we can best equip your child (this information is confidential). If none, enter "none." *
Your answer
Child 2
Name of Child
Your answer
Birthdate of Child
MM
/
DD
/
YYYY
Grade for 2017-2018 School Year
School Attending
Your answer
Please list any allergies, medical conditions, or learning differences, as well as how we can best equip your child (this information is confidential). If none, enter "none."
Your answer
Child 3
Name of Child
Your answer
Birthdate of Child
MM
/
DD
/
YYYY
Grade for 2017-2018 School Year
School Attending
Your answer
Please list any allergies, medical conditions, or learning differences, as well as how we can best equip your child (this information is confidential). If none, enter "none."
Your answer
We take pictures and videos of kids doing projects or activities from time to time, and use them for slides, videos, and other promotional materials, which may include social media. Do you give Aldersgate United Methodist Church the rights to use images of your child for these purposes? *
Anything else we should know?
Your answer
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