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Child's Last Name:

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Child's First Name:

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Child's Middle Initial:

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Address:

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Home Phone:

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Cell Phone:

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Work Phone:

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Parent/Guardian Name(s):

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Birthdate:

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Age:

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* Grade Going Into:
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Allergies/Medical Information/Other:

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Email Address:

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Emergency Contact Name and Phone Number (If needed during extracurricular events):

15.
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Are parents interested in helping with Sunday School or Christian Education Activities?

Yes   No
16.
* The Union-Congregational Church of Waupun may include images on our website, brochures, or other forms of media to promote the positive activities happening at our church. Names will never be used on the site to directly identify youth. Please indicate your preference below.
Yes, I give permission for Union-Congregational Church to use a photograph or image of my child in publications, news releases, on the church web pages, newsletter, brochures, etc.   No, I do not give permission

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