Seattle Bethany Church - North Sunday School registration

Child First Name

Child Last Name

Child Date of Birth MM/DD/YYYY

Street Address 1

Street Address Line 2

Apt.

City

State

Zip/Postal Code

First Name

Last Name

Email

Phone Number

First Name

Last Name

Relationship

Phone Number

Any Allergies or Medical Conditions?
Yes
No

If Yes, please give details

Do you want to add something about your child?

I, undersigned, agree with the following statements:

I am the parent/guardian of the child indicated above.
Yes

If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatment for my child.
Yes

I am giving my permission to take my child's pictures for classroom projects and post them on the church website.
Yes