Please enable JavaScript in your browser to complete this form.Youth InfoEmail *Name *FirstLastNickname/name preferredPronoun preferenceShe/her/hersHe/him/hisThey/them/theirsOtherPlease tell us your pronoun preferenceCell PhoneHome PhoneDate of BirthPlace of BirthSchool year2021 to 20222022 to 20232023 to 20242024 to 20252025 to 2026Select grade in school 2020–2021 (if applicable)6th7th8th9th10th11th12thPhoto AuthorizationI give my permission for First Presby to use the photos of my child for any legal use, including but not limited to: publicity, copyright purposes, illustration, advertising, social media, and web content. *YesNoParent/Guardian InfoParent/Guardian Name *FirstLastEmail *Relationship to ChildMotherFatherStep-parentGrandparentOther caregiverHome PhoneCell PhoneWork PhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you need to add additional parent/guardian fields?NoYesAdditional Parent/Guardian InfoAdditional information if parents are separated or divorcedParent/Guardian NameFirstLastEmailRelationship to ChildMotherFatherStep-parentGrandparentOther caregiverHome PhoneCell PhoneWork PhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWho has primary custody?FirstLastDo you need even more to add additional parent/guardian fields?NoYesAdditional Parent/Guardian Info x2Parent/Guardian NameFirstLastEmailRelationship to ChildMotherFatherStep-parentGrandparentOther caregiverHome PhoneCell PhoneWork PhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWho has primary custody?FirstLastOtherWhen church school is over at 10:30, we need to know if your child will be picked up from class or allowed to leave on his/her own. Please select the appropriate option and make sure your child is aware of this decision: My child will be met by a parent/grandparent/guardian My child will be met by an older siblingMy child has my permission to leave the classroom my him/herself Sibling's nameFirstLastDoes your child have any allergies, food or otherwise? NoYesPlease list and tell us what to do in case of an allergic reaction: Any other information which would be good for us to know about your child as she or he enters this new year of church school?Submit
