Student Name *
Student Name
Birthdate *
Birthdate
Address *
Address
Parent Name *
Parent Name
Parent Name
Parent Name
Address (if different)
Address (if different)
Cell Phone *
Cell Phone
Home Phone
Home Phone
Please indicate how you are willing to support the RE program.
Please type your name here if you give permission for your child to receive emergency medical treatment in your absence.
We take photographs and videos of church congregants in action as they participate in classrooms, field trips, intergenerational events, social justice activities, etc. Please indicate below what uses of images of you or your child you are willing to consent to. In any use of images names and other personal information will NOT be identified. Please type your and your child's name and date.
Images of my child(ren) may be used for internal publcation (newsletter, email, etc.).
Images of my child(ren) may be used on the church website and facebook page.
Images of myself may be used for internal publication (newsletter, email, etc.)
Images of myself may be used on the church website and facebook page.