Please complete a new registration form for the 2011-2012 year for your 1st to 6th grade children. One form per child is required. This one form will be good for all Saturday/Sunday School classes and Wednesday Clubs.
Child's Name *
Saturday p.m.
Sunday 8 a.m.
Sunday 9:30 a.m.
Sunday Churchtime (for kids attending 2 hours only)
Sunday 11 a.m.
Wednesday Clubs
Birthdate *
Age *
School Grade *
School Child Attends
Male
Female
Street Address *
City, State ZIP *
Parents/Guardians *
Home Phone # (include area code) *
Cell Phone # (include area code)
Alternate Phone # (include area code)
Parent E-mail *
Alternate E-mail
My child has the following special needs (include any allergies).
List special needs:
I give my permission that photos or video may be taken at Kids Lighthouse activities, and potentially used in EFCC picture slide shows/videos, printed pieces, or electronic media (like e-mail and the EFCC web site).
Yes, I give my permission
No
Location of Parents/Guardians on Saturday Night/Sunday morning for each service attended
(example: 9:30 church service, 11:00 serve in 3's-4's class, etc.)
For the safety of your children, please DO NOT bring them prior to 6:45 p.m. Your child MUST be picked up at 8:30 p.m.
Location of Parents/Guardians on Wednesday Night
Child is brought by Parents? Guardians? High school age sibling?
They can be reached at (enter phone # with area code)
Other adult(s) my child can be released to
Friends you would like in your child's small group
I Agree
I understand that an adult (parent / guardian, or high school age sibling) MUST drop off and pick up ALL children (birth to 5th grade) to/from their classrooms for Wednesday Clubs and Saturday / Sunday School. 6th graders only will be released to meet their parents.
For the safety of your children, all children 3-years-old to 5th grade must be checked-in and checked-out at their classrooms by a parent, guardian, or high school age sibling. 6th grade children will continue to be released to their parents.