Children's Ministry Registration

3 years through 5th grade

Sunday Morning Sunday School 10:00 - 10:45 a.m.
Wednesday Evening Kid's Club 6:30 - 7:30 p.m.

Contact: Patti Sailer or Lorin Zuppe
Phone:  330-499-3307
Fax: 330-499-2319
Email: patti@holycrossnorthcanton.com
           lorin@holycrossnorthcanton.com

Child's Info
Name
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Age
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Grade
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Birth Date //
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Address
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Parent's Info
Parents need to remain present in the church building during Christian Education time and are encouraged to attend Adult Bible study!
Mother's Name
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Mother's Phone --
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Father's Name
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Father's Phone --
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E-mail
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In the event that parents cannot be contacted, who else should we contact in an emergency?
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Emergency contact phone number --
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Home Church
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Allertness
Please list any allergies, medical conditions or other considerations that we may need to know about.
Allergies
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Medical Conditions
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Anything else we need to know about?
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Parental Consent
Media Release
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Permission is granted to Holy Cross Lutheran Church to use my child's photograph, slide, and/or audio in its media releases, publications, presentations and/or web pages.
Signature
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By typing your name in this field you are affirming that everything listed on this form is accurate to the best of your knowledge.
Today's Date //
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