Register Here! Url Family Name * Family Mailing Address * Home Phone Name - Parent/Guardian 1 * Cell Phone - Parent/Guardian 1 * Email - Parent/Guardian 1 * Name - Parent/Guardian 2 Cell Phone - Parent/Guardian 2 Email - Parent/Guardian 2 Student Name (1) * M/F * Grade Birthdate * Allergies / Medical Concerns * Student Name (2) M/F Grade Birthdate Allergies / Medical Concerns Student Name (3) M/F Grade Birthdate Allergies / Medical Concerns Student Name (4) M/F Grade Birthdate Allergies / Medical Concerns Media Release * YesNo I give permission to Second Congregational Church to take and use photos, video and/or audio recordings of my child(ren) for use in informational materials for the church, except as noted below: Exceptions Permission to Participate in On-Line Programs * YesNo I give permission for my child(ren) to participate in on-line programming, including live-streamed services and Zoom-based class sessions, with the following restrictions: Restrictions Added Notes What suggestions or recommendations would you make to help us teach your child(ren)? Please indicate any learning challenges, special needs or other circumstances that teachers should know in order to best care for your child. Parent/Guardian Signature * Your name here is understood to be your electronic signature. Date *
