Middlebury Congregational Church Sunday School Registration Form 2022-2023
Please fill out this form and click submit.
Parent/Guardian Name
*
Additional Parent/Guardian Name
Email
*
This address will receive a confirmation email
Phone
*
Phone (2)
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Child Name (1)
*
Child 1 Birthdate
*
Child 1 Grade (2022-23 school year)
*
Please select one option.
Baby/Toddler
PreK
K
1
2
3
4
5
6
7
Child 2 Name
Child 2 Birthdate
Child 2 Grade (2022-23 school year)
Please select one option.
Baby/Toddler
PreK
K
1
2
3
4
5
6
7
Child 3 Name
Child 3 Birthdate
Child 3 Grade
Please select one option.
Baby/Toddler
PreK
K
1
2
3
4
5
6
7
Child 4 Name
Child 4 Birthdate
Child 4 Grade
Please select all that apply.
baby/toddler
PreK
K
1
2
3
4
5
6
7
Does your child(ren) have any allergies, medical conditions, dietary considerations, or special needs we should know about? If so, please describe and include any accommodations necessary.
*
Emergency Contact: Name, relationship, phone number
*
Alternate Person Responsible for pick-up
Permissions: Photos may taken and be used for: bulletin boards, publications (Church newsletters, newspaper), MCC website and/or Social Media.
*
Please select all that apply.
I acknowledge and agree
Due to the changes in the Covid-19 Pandemic, precautions such as masking may be necessary depending on community levels. All participants must follow all regulations, such as masking, if required.
*
Please select one option.
I acknowledge and agree
My child/children has permission to participate in the MCC Sunday School events between September 2022 and July 2023. I understand that I may not hold MCC liable in case of accident or injury to my child. I give permission for medical care to be given should my child need treatment before I am contacted.
*
Please select one option.
I acknowledge and agree
Submit
Description
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