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 year2023 to 20242024 to 20252025 to 2026Select grade in school 2023–2024 (if applicable)1st2nd3rd4th5th6th7th8th9th10th11th12thPhoto 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 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict 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 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict 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 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWho has primary custody?FirstLastOtherWhen church school is over at 10:15, 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/guardianMy child will be met by an older siblingMy child has my permission to leave the classroom my him/herselfSibling'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
