¥   Lakewood Congregational Church (UCC)   ¥

2009 – 2010 Faith Formation and Choir Registration

 

NOTE TO PARENTS

Please fill one form out for each child, as we want each teacher to have this information available about each student in his or her class.

Please Print

Student Name                                                          Date of Birth                                              

 

Residence Address                                                                                                            

 

Residence Telephone #                                             Grade in School              Age             

 

Parent/Guardian Name                                                                                                                                              

 

Parent/Guardian cell phone                                        Student cell phone                            

 

Other Parent Information (second address/phone, stepparent name, etc.)

 

                                                                                                                                     

 

Family email                                                  Student’s email                                           

 

If you cannot be reached in an emergency, who should we contact?

 

Name                                         Telephone                                 Relationship                   

 

Please list ALL persons who have permission to pick up your child from class, if you prefer to have them dismissed to you, or simply dismissed:

 

                                                                                                                                     

 

Is there any medical information we should know about your child? (Allergies, medications, special needs, etc.)

                                                                                                                                     

 

                                                                                                                                     

 

I would also like to register my child for the choir checked below:

 

          o CHERUB CHOIR    Age 4 – Grade 2           o YOUTH CHOIR Grade 7 – Grade 12

          o COVENANT CHOIR Grade 3 – Grade 6

 

Would you consider participating as a Teacher/Leader Sunday morning, choir helper, and/or a substitute Teacher/Leader on the Children’s or Adult Education Team, or for a special event?

                                                                                                                                     

 

 

Person completing this form:                                                                 Date