Sunday School Registration Form

EASTSIDE LUTHERAN SUNDAY SCHOOL 2010-2011 REGISTRATION FORM

Names of Parents or Guardian:________________________________________

Address: _________________________________________________________

Phone Number(s): _________________________________________________

Emergency Contact Person(s) and Phone Number: _______________________

Email Address: ____________________________________________________

LIST CHILDREN ATTENDING SUNDAY SCHOOL BELOW

(for children 4 years old by 9-1-10 through eighth grade)

Child's Name: ______________________________________________________

Has child been baptized? Yes _______ No _______

Child's date of birth: ___________________

Grade entering fall of 2010 (circle one): 4 yrs K 1 2 3 4 5 6 7 8

Child's Name: ___________________________________________________________

Has child been baptized? Yes _______ No _______

Child's date of birth: ______________

Grade entering fall of 2010 (circle one): 4 yrs K 1 2 3 4 5 6 7 8

Child's Name: ___________________________________________________________

Has child been baptized? Yes _______ No _______

Child's date of birth: ______________

Grade entering fall of 2010 (circle one): 4 yrs K 1 2 3 4 5 6 7 8

Do any of the children above have any health problems of which we should be aware?

(Please be specific, thank you):

Child(ren)'s Name(s): __________________________________________

Parent or Guardian's Name: _____________________________________

Child(ren)'s 2010-2011 Grade(s): _________________________________

Please draw a line through any items that you may wish to delete and then initial them. If you wish to complete a separate form for each child, please request additional forms from the Sunday School Administrative Committee.

By signing this form I am giving Eastside Lutheran Sunday School, Madison, Wisconsin, the right to use my child(ren)'s photographs or videos which includes my child(ren) in promotional materials. These may include posters used in our church or school, posters used to recruit at other recruitment locations, informational brochures on Sunday School programs, church web site, area newspaper articles, magazine articles, newspaper advertisements, magazine advertisements, advertisement flyers or promotional videos. Children will not be identified by name, unless a specific request is made to the parent or guardian.

Signature for release: ___________________________________________________(parent or guardian)

Date: ________/___________

Administrative Committee Use Only

_______ Photos may be used without any restrictions as indicated above.

_______ Photos may be used with the restrictions as indicated above.

_______ Photo may not be used