Thursday School Registration - Goodman Oaks Church of Christ

Child's Info

Child's Name: *

Preferred to be Called:

Date of Birth *

Current Age: *

Gender: *

Male

Female

Address

Street: *

City: *

State: *

Zip *

Parental Info

Father's Name: *

Cell Phone: *

Home Phone:

Work Phone:

Mother's Name: *

Cell Phone: *

Home Phone:

Work Phone:

Email Address: *

Church Affiliation

List Child Allergies: *

Emergency Record

Our Staff of willing and capable teachers will do all that is possible to make your little child happy, secure, and safe. However, please fill out this portion as a precautionary measure.

I authorize the Thursday School Staff *

I authorize the Thursday School Staff to contact the following if I cannot be reached in case of an emergency, illness, or accident:

I will not hold Goodman Oaks Church *

I will not hold Goodman Oaks Church, Thursday School, or any staff member thereof responsible for illness or accidents incurred while my child is in their care.

Emergency Contacts

1st Contact Name: *

Relationship: *

Cell # *

Home #

Work #

2nd Contact Name:

Relationship:

Cell #