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Wellesley Congregational Church
Church School Registration
2011 - 2012
*
Required
Errors
Form Submitted By:
*
Child # 1 (please list additional children below)
Last Name:
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First Name:
*
Goes by Name:
Birth Date:
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Gender:
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Male
Female
Grade as of 9/1/2011:
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Parent/Guardian's Name:
*
Parent/Guardian's Name:
*
Address Line 1
*
Address Line 2
City
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State
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AL
AK
AS
AZ
AR
CA
CO
CT
DE
DC
FL
FM
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MH
MI
MN
MS
MO
MP
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VI
VT
VA
WA
WV
WI
WY
ZIP Code
*
Phone Number:
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(
)
-
ext.
Parent #1 Email Address:
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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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