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Getting to Know you FormFor Church of the Good Shepherd Children’s ProgramsOne registration form per family. Please list children in order of age oldest to youngest.38100228600Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:____________________________Sex: M F Grade in the Fall 20____ : Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Parent(s)/Guardian(s) Name:_______________________________________________________________Address:_______________________________________________________________________________City/State/Zip:__________________________________________________________________________Phone: home_____________________ work________________________ cell_______________________E-mail Address:__________________________________________________________________________Do you wish to EXCLUDE your children’s photographs or images from use? YES____ NO____Have your children been baptized? YES____ NO____Would you like to be contacted about baptism? YES____ NO____Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:_________________Sex:M F Grade in the Fall 2013: Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Child’s Name:______________________________________________________________Birthdate:____________________________Sex: M F Grade in the Fall 20____ : Pre* K 1 2 3 4 5Known Medical Conditions and/or Allergies and level of severity:______________________________________________________________________________________________________________________________________________________________________________Parent(s)/Guardian(s) Name:_______________________________________________________________Address:_______________________________________________________________________________City/State/Zip:__________________________________________________________________________Phone: home_____________________ work________________________ cell_______________________E-mail Address:__________________________________________________________________________Do you wish to EXCLUDE your children’s photographs or images from use? YES____ NO____Have your children been baptized? YES____ NO____Would you like to be contacted about baptism? YES____ NO____ ................
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