EmailMe Form - Emmanuel Church Sunday School Registration

Child's Information
Please complete a separate form for each child attending Sunday School.
Child's Name *
First Last
Birthday *
MM / DD / YYYY
Gender *
Grade Completed *
Any Allergies / Medication *
Parent / Guardian Information
Parent / Guardian Name *
First Last
Home Phone *
### - ### - ####
Cell Phone
### - ### - ####
Work Phone
### - ### - ####
Parent / Guardian Name
First Last
Home Phone
### - ### - ####
Cell Phone
### - ### - ####
Work Phone
### - ### - ####
Email
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Emergency Contact Information
In case neither parent is able to be reached, who should we contact in case of an emergency?
Name *
First Last
relationship to child *
Primary Phone *
### - ### - ####
Secondary Phone
### - ### - ####
Any Additional Notes for the staff: