| Date __________________________
Student Name
_______________________________________________________________
(Last)
(First) (Middle)
Birth Date ______________________ School Grade ____________________
Known Allergies or other Medical Concerns
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
Parents’ or Guardians’ Name(s)
_______________________________________________________________
_______________________________________________________________
Address ________________________________________________________
Home telephone ______________________ Work telephone _____________
Emergency Contact Person _________________________________________
Telephone ______________________________________________________
Brothers and Sisters (names and ages):
________________________ _________________________
________________________ _________________________
|
Do you have time and/or a special talent that you would be
willing to share with the
children? Being a teacher, a teacher's aide, assisting with Church or
Nursery, helping with "Time for Children" during the Church Service, are just
a few of
the ways you could make a difference in the lives of OUR CHILDREN. If you
can
help, please contact the Church Office, or the
Pastor.
United Church of Christ, Greenawalds
2325 Albright Avenue
Allentown, PA 18104
Back to the
Christian Formation Page |