SUNDAY SCHOOL REGISTRATION FORM 2023-2024
Please note that you must fill out a separate form for each child.
Child's Information
Name (First/Last):
*
Nickname:
Birthdate:
*
Age:
*
- -
< 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Gender:
*
- -
Male
Female
Last Grade completed:
*
- -
PS
K
1
2
3
4
5
6
7
8
9
10
11
Have you been confirmed?
*
yes
no
Address:
*
City:
*
State:
*
- -
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
*
Child's Cell Number
(if any)
Child's Email Address:
(if any)
Family's Email Address:
*
Parent/Guardian #1
Name
*
Cell Number
*
Email Address
*
Parent/Guardian #2
Name
Cell Number
Email Address
Emergency Contact
Name
*
Contact's Relationship
*
Contact's Phone
*
Allergies/Special Concerns:
Physician
*
Physician's Phone:
*
Child Release
-- (additional individuals authorized to pick-up your child, other than listed above):
*
Children up to grade 3 will wait in their classroom for the designated individual; all other children will be dismissed to Founders Hall.
Consent
If I cannot be reached and RCCPC's representative has made every attempt to reach appropriate persons listed above, I agree to assume all expenses for moving and medically treating this child. I also hereby consent to any treatment, surgery, diagnostic procedure or the administration of anesthesia, which may be carried out based on the medical judgment of the attending physician.
*
Yes
No
In consideration of being permitted to participate in activities which are sponsored by RCCPC or in which it participates, I hereby release, waive, discharge, and covenant not to sue RCCPC, its officers, servants, agents, volunteers, or employees from any and all liabilities, claims, demands or injury that may arise from or be sustained by my child while participating in any activity sponsored by or conducted in conjunction with RCCPC, whether or not located on property belonging to RCCPC.
*
Yes
No
I give permission for my child to attend and participate in all youth group activities whether at RCCPC or at other locations.
*
Yes
No
I understand that it is my child's responsibility to come to RCCPC ready to help promote a positive learning environment for all children. My child is expected to be respectful of teachers, fellow classmates, and the property of others. I understand that if my child is having difficulty with these expectations, the teacher will use effective educational discipline techniques to encourage the cooperation of the child. If my child continues to cause a disturbance, I understand that it is my responsibility to pick him/her up immediately.
*
Yes
No
I acknowledge that photos may appear on the RCCPC website or social media and understand that under no circumstances will children/youth in those photos be identified with names or other personal information. I reserve the right to have any photo of my child removed upon request.
*
Yes
No
