Today's Date: ____________________________________________________________________________________________________

 

Child's Name: ____________________________________________________________________________________________________

 

Birthday: _______________________________     Age: _____________ Grade: ______________________________________________

 

Place of Baptism: ____________________________________________  Date (if known): ______________________________________

 

Parent's Name: ___________________________________________________________________________________________________

 

Home Address: ___________________________________________________________________________________________________

                      

                        ___________________________________________________________________________________________________

 

 

Home Phone Number: _____________________  Cell Number: ____________________________________________________________

 

Email Address: ___________________________________________________________________________________________________

 

Any Medical Concerns, Allergies or special notes: _______________________________________________________________________

 

________________________________________________________________________________________________________________

 

 

Emergency Contact: _______________________________________________________________________________________________

 

________________________________________________________________________________________________________________

 

 

 

 

I give _________ Do not give ________  permission for my child's photo to appear in St Paul's Episcopal Church photographs related

                                                                to Church School and Church events.

 

I will __________  I will not __________  be in town during February vacation.

 

I will __________  I will not __________  be in town during April vacation.

 

 

 

 

Comments or Suggestions:  _________________________________________________________________________________________

 

                                          _________________________________________________________________________________________