Kids Registration Form THREE

Child Name *

First

Last

Birthdate *

Grade *

Nursery (birth-2 years old)
Preschool (3-4 years old)
Pre-K (4 years or older by Sept. 1-going into Kindergarten the next school year.)
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade

School

Does your child carry an EPI pen?

Yes
No

Medical History

If "other," please describe, also list allergies/dietary restrictions:

MEDICAL RELEASE: In the event of accident, injury, or illness, I authorize any and all medical attention necessary to be administered to my child, listed above, under the direction of such medical professionals as the Church determines appropriate under the circumstances. Please print your signature below: *

WAIVER: By sending my child to Sewickley Presbyterian Church (SPC) events, I agree to indemnify and hold harmless Sewickley Presbyterian Church, its staff, volunteers, or anyone affiliated with SPC, from any liability for an accident or injury which may be incurred. Please print your signature below: *

Todays' Date: *

KIDS DIGITAL REGISTRATION FORM: THREE

Church Office Hours

Locate Us

Newest Newsletter

Church Member Log-In

Employment Opportunities

Deacon Resources

SPC Blog