Wellesley Congregational Church - Wellesley, MA: Registration

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HOME > CHURCH SCHOOL > Registration

Wellesley Congregational Church

Church School Registration

2011 - 2012

* Required

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Form Submitted By: *

Child # 1 (please list additional children below)

Last Name: *

First Name: *

Goes by Name:

Birth Date: *

Gender: *

Male

Female

Grade as of 9/1/2011: *

Parent/Guardian's Name: *

Address Line 1 *

Address Line 2

City *

ZIP Code *

Phone Number: *
( ) - ext.

Parent #1 Email Address: *

Parent #2 Email Address: *

Please list any special needs, allergies, talents or interests that would help us in our relationship with your child:

Please indicate an area in which you are willing to help our program this year:

Co-Teach a 3 year old, Pre-Kindergarten Class:

Fall

Winter

Spring

Teach a Rotation Workshop:

Art

Cooking

Games

Science

Storytelling

Teach Rotation Workshop Term:

Fall

Winter

Spring

Co-Shepherd:

Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Provide childcare during worship once a month:

Infants

Twos

Additional information:

Child # 2

Last Name:

First Name:

Goes by Name:

Birth Date

Gender

Male

Female

Grade as of 9/1/2011

Please list any special needs, allergies, talents or interests that would help us in our relationship with your child:

Child # 3

Last Name:

First Name:

Goes By Name:

Birth Date

Gender:

Male

Female

Grade as of 9/1/2011

Please list any special needs, allergies, talents or interests that would help us in our relationship with your child:

Child # 4

Last Name:

First Name:

Goes by Name:

Birth Date

Gender

Male

Female

Grade as of 9/1/2011

Please list any special needs, allergies, talents or interests that would help us in our relationship with your child:

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