2020-2021 Church School Registration

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Parent Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Child 1

Child 1 Name

*

Child 1 Grade

*

Please select all that apply.

Age 3 Age 4 Age 5 or PreK Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade 7th grade 8th grade 9th grade 10th grade 11th grade 12th grade

Child 1 Allergies or anything we should know

Child 2

Child 2 Name

Child 2 Grade

Please select all that apply.

Age 3 Age 4 Age 5 or Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Child 2 Allergies or anything we should know

Child 3

Child 3 Name

Allergies or anything we should know

Child 3 Grade

Please select all that apply.

Age 3 Age 4 Age 5 or Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade

Suggested Donation - $15.00 per student

Donation

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

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