This is the information for the primary adult with whom the child is attending church.
If cell is the only phone, enter None
If none, enter None
Date of Birth
Grade (or last completed)
If Child lives with primary adult listed above, and has the same Address/Phone number, check here
If DIFFERENT, please list child's Address, Phone number and parent(s)'/guardian(s)' names.
Grade (or Last Completed)
Please list names, birthdates and grade (or last completed)
Anything you would like to let us know about your child(ren) or questions you might have, please enter them here.