Your Name: (required)

Your Email: (required)

Your Child's Name: (required)

Date of Birth: (required)

Age: (required)

Last Grade of School Completed: (required)

Parents'/Guardians' Name: (required)

Street Address: (required)

City: (required)

ZipCode: (required)

Home Phone Number: (required)

Cell Phone Number: (required)

Work Phone Number: (required)

Work Phone Number: (required)

Emergency Contact Name: (required)

Emergency Contact Phone: (required)

Emergency Contact Relationship to Child: (required)

If you are new to Prince of Peace, where did you attend church before and did you participate in their Sunday School program?
 Yes No

Photo Release: (Identifying information such as name is not used)

Can your child be photographed? Yes No

Can the picture appear in church news articles in print? Yes No

Can the picture appear on the internet (Website,Facebook, ect.)?  Yes No

Release Form: By checking the box, I (we) understand that Prince of Peace Presbyterian Church will take every precaution possible to ensure the safety of students and are not responsible in the event of accident.  Yes, I agree to the release form.

Parent/Guardian Signature: