| Child's Name: |
| Last Name*: | |
| First Name*: | |
| Child likes to be called: | |
| |
| Gender*: | M F |
| |
| Birth Date* (mm/dd/yyyy): | |
| |
| Current Age Group:*: | |
| |
| On an average Sunday (Sept-June), please indicate the approximate times your child will need nursery care (check as many as apply): |
9:00 - 10:45 a.m.
10:00 a.m. - 12:15 a.m.
12:15 - 1:00 p.m.
1:00 - 2:30 p.m.
|
Contact Information
Mailing Address |
| Street*: | |
| Apt. #: | |
| City*: | |
| State*: | |
| Zip Code*: | |
| |
Parent Information
Parent 1 |
| Name*: | |
| Email: | |
| Home Phone*: | |
| Work Phone: | |
| Cell Phone: | |
Parent 2 |
| Name*: | |
| Email: | |
| Home Phone*: | |
| Work Phone: | |
| Cell Phone: | |
Other Important Information
|
| Special Needs, Allergies, Medications: | |
| Emergency Contact:* | |
| Relationship:* | |
| Phone:* | |
|
| Pediatrician*: | |
| Phone: | |
|
| Is there anything else you would like us to know about your child that would improve his or her experience at Plymouth? | Yes. Please have Julia Rassmann call me to discuss.
Yes. I will be in touch with Julia Rassmann by email.
N/A
|
Photography Permission
|
Yes, I give Plymouth Church permission to use my child's likeness and/or image for promotional purposes in print materials and digital media including the Plymouth Church web site. I understand that children in these images will not be identified by name.
No, I do not give permission.
Each member parent (Dad too!) is expected to volunteer a minimum of two times a year in support of Plymouth's family programs. Please indicate which activities either parent would be interested in volunteering for (check as many as apply):
DiscoveryLand assistant teacher for age group:
Children's Church traffic guide/monitor
Christmas Pageant volunteer (December 2011)
Vacation Bible Camp volunteer (August 2012)
Volunteer at Sunday special events (such as PumpkinLand, ValentineLand)
Volunteer at Saturday &/or evening special events (Easter Egg decorating, summer Playground Fun, movie night)
Information Table helper during Fellowship Hour (as needed for registration drives, volunteer sign-ups, etc.)
If you have questions or comments about DiscoveryLand and/or volunteer opportunities, please contact Julia Rassmann, Director of the Ministry to Families and Children, at the Church Office.
|
|
