RIVERSIDE UNITED CHURCH
Text Box: Christian Education School and Nursery Registration 2009 - 2010 One student/child per form—PLEASE PRINT Date __________________ Student Name:_________________________________________________ M or F Date of Birth: ________________ Current Age: ______ Grade Level: ______School: ___________________________ Main Residence Address: ____________________________________________ City: _______________________________ Postal Code: __________Home Phone: _______________________ Alternate Phone: ________________________________ Email address: _______________________________________ Parents/Guardians Names: ____________________________________________________ Alternate Residence (if applicable) Address:________________________________________________________ City: ________________Postal Code: ________Home Phone: ________________ Alternate Phone: ________________________ Email address: ______________________________________________________________ Any allergies or special needs Y N If so, please describe:________________________________________________________ _______________________________________________________________________________________________________________ OHIP Number: ______________________ List your child’s special interests:___________________________________________________________________________________ Will you allow your child’s photo to be published in church publications and website? Y N Has your child been baptized? Y N There are many areas in the Sunday School and Nursery program where you can actively participate. I am not able to participate _____ Yes, I would like to participate in the following: Occasionally provide baking goods ___ Volunteer on the Christian Education Committee____ Other: ______________________________________________________________________________ The Riverside United Church , Sunday school begins, September 6, 2009 I give my child permission to enroll as a student for Christian education. Please sign and return the completed form to the Church School Coordinator Signature