Christ Church Bells Corners

Church School and Nursery Registration Form 2017–2018

This is a two-sided form. Please print clearly.

Parent(s) Names: ______

Address: ______

______

Phone (home): ______Phone (emergency): ______

Email #1______Email #2______

I would like to receive newsletters and information by email: ____yes ____no

Child #1 Name:______Birthdate: ______

School:______Grade:______

Allergies/Health Concerns*:______.

*Life-threatening health issues will be shared with our teaching team.

My child regularly receives communion ____yes ____no.

Child #2 Name:______Birthdate: ______

School:______Grade:______

Allergies/Health Concerns*:______.

*Life-threatening health issues will be shared with our teaching team.

My child regularly receives communion ____yes ____no.

Child #3 Name:______Birthdate: ______

School:______Grade:______

Allergies/Health Concerns*:______.

*Life-threatening health issues will be shared with our teaching team.

My child regularly receives communion ____yes ____no.

Child #4 Name:______Birthdate: ______

School:______Grade:______

Allergies/Health Concerns*:______.

*Life-threatening health issues will be shared with our teaching team.

My child regularly receives communion ____yes ____no.

I give permission for use of my child’s/children’s photograph(s) in parish publications and/or the Diocesan newspaper, Crosstalk: ___yes ___no ___with his/her name ___without name; and on the CCBC website/Facebook (no names) ___yes ___no.

______

Parent/Guardian’s signature Date

* * * * * * * *

Information Requests and Volunteer Opportunities

I would like to receive more information about:

____ Young Children and Communion ____ Baptism and Confirmation

____ Servers’ Guild (grade 6 and up) ____Junior Choir (grades 1 and up)

____ Cooking with Sam ____ Funky Monkeys (grades 2–5)

____ Activity Day Programs ____ The Youth Group (grades 6–12)

I would be interested in helping with the following:

____Church School Support Committee ____ Summer Church School

____Activity Days (Saturdays) ____ Activity Days (Weekdays)

____Church School Special Events ____ Pageants

All information is valid for one year and for church use only.

For New Members

Welcome to CCBC Church School and our parish family. Your contact information will be shared with the office and you will be placed on our parish list. Please check the appropriate box:

I would like to: □ have clergy call

□ receive offering envelopes

□ be placed on PAR (Pre-Authorized Remittance)

□ receive parish mail electronically

Name:______Phone:______

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