Nursery/Sunday School Enrollment Card 2009-2010

Child's Name (First & Last)*

Birthdate*

Sex*

Age or Grade as of 9/1/09*

Family Email Address*

School Attending as of 9/1/09*

Street Address*

City*

State*

Zip*

Home Phone*

Mother's Name*

Mom's Address (if different from child)

Mom's Cell Phone

Father's Name*

Father's Address (if different from child)

Father's Cell Phone

Describe allergies, limitations or special needs, which we should be aware of.

Which hour/hours will your child be attending?

Where will you be located during the above hour/hours?

	To prevent spam, please answer the following question. What is nine added to three?*