Saint Peter’s Episcopal Church
2009 - 2010 Children & Youth Registration Form
(Confidential – not for publication or distribution)
Parent(s) / Guardian(s)
Name: _____________________________________________________ Relationship: ___________________
Address: __________________________________________________________________________________
E-mail: (To contact you regarding
Home phone: _________________________________ Cell phone (optional): __________________________
Emergency contact information: a parent/guardian is expected to be on church property when child is in class & worship:
Media and Photo Release Form
I hereby give permission for this parish to use my child’s photograph (without their name) on the parish website and in news releases in regard to any parish sponsored activity. (If filling out online, please type in name and date.)
_____________________________________________ _____________________________
Parent/Guardian Signature Date
Specific things I would like my child(ren) to learn this year, e.g. Creed, Lord’s Prayer, etc.
Parents: We need your help to ensure the success of our church school program. If you are willing to help us out by volunteering to become part of the teaching team for any of our classes or in assisting with special events, would you indicate your intent by printing your name(s) below? Thank you!
I/we want to join a teaching team: ___________________________________ Grade level: ____________
I/we will assist in special programs: _________________________________________________________
PLEASE SEE REVERSE FOR CHILDREN’S INFORMATION SECTION
Child / Youth 1.
Name: _____________________________________________________ Nickname: _____________________
First Middle Last
Date of birth: __________________________ Gender: M ____ or F ____
School attending: _________________________________________________ Grade as of 9/1/09: ____________
Date of baptism: _________________ Church: ___________________________ Denomination: _____________
Please note any allergies (health, dietary) or other concerns that we should be aware of:
Should we be aware of any learning challenges your child faces?
Child / Youth 2.
Name: _____________________________________________________ Nickname: _____________________
First Middle Last
Date of birth: __________________________ Gender: M ____ or F ____
School attending: _________________________________________________ Grade as of 9/1/09: ____________
Date of baptism: _________________ Church: ___________________________ Denomination: _____________
Please note any allergies (health, dietary) or other concerns that we should be aware of:
Should we be aware of any learning challenges your child faces?
Child / Youth 3.
Name: _____________________________________________________ Nickname: _____________________
First Middle Last
Date of birth: __________________________ Gender: M ____ or F ____
School attending: _________________________________________________ Grade as of 9/1/09: ____________
Date of baptism: _________________ Church: ___________________________ Denomination: _____________
Please note any allergies (health, dietary) or other concerns that we should be aware of:
Should we be aware of any learning challenges your child faces?
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