EmailMe Form - St. Augustine Youth Programs: Fall 2013

Student's Name *

First Last

Gender *

Male

Female

Birthdate (mm/dd/yyyy) *

Grade entering this fall *

Please list any allergies or special needs about which the teaching staff should know. (if there are none, please type "none") *

Parent/Guardian *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Family Email Address *

Confirm

Home Phone *

### - ### - ####

Parent Cell #1 *

### - ### - ####

Parent Cell #2

### - ### - ####

Emergency Contact
(please choose one) *

I will be in the church building during Sunday School

I do not plan to be in the building during Sunday School. Please use the emergency contact information listed below:

Emergency Contact

First Last

Emergency Contact Phone

### - ### - ####

Group and individual pictures may be taken during Sunday School,
the worship service and during special events.
Please select one of the following: *

My child's likeness may be obtained and used on the church website, in digital format, or in printed publications.

My child's likeness may NOT be obtained and used on the church website, in digital format, or in printed publications

Are you willing to help with
Sunday School this year?
(if you check "yes", we will
contact you with more information)

Yes

No