Wyalusing Presbyterian Church

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Sunday School 2022-2023 Registration

Email *

Name of Child #1 *

Date of Birth for Child #1 *

YYYY

Age Group for Child #1 *

Child #1 Medical Considerations and/or Allergies *

Name of Child #2

Date of Birth for Child #2

YYYY

Age Group for Child #2

Child #2 Medical Considerations and/or Allergies

Name of Child #3

Date of Birth for Child #3

YYYY

Age Group for Child #3

Child #3 Medical Considerations and/or Allergies

Mailing Address *

Contact name and contact number for Parent/Guardian *

Emergency Contact (name and number must be different than above name and number) *

Adult(s) that Child/ren May be Released To (other than those already listed)

Media Release (For pictures and videos ONLY) Please note this includes PUBLIC social media *

You may use photos and/or video taken of my child/ren for advertising, newspaper publications, website photos, and social media.

You may NOT use photos and/or video taken of my child/ren for advertising, newspaper publications, website photos, and social media.

Media Release (For LIVE STREAMING and/or LIVE BROADCASTING) on PUBLIC social media *

I grant Wyalusing Presbyterian Church permission to live stream and/or broadcast my child/rens participation in Sunday School events and/or church services and/or events through various PUBLIC platforms.

I do NOT grant Wyalusing Presbyterian Church permission to live stream and/or broadcast my child/rens participation in Sunday School events and/or church services and/or events through various platforms.

Volunteer *

I am willing to turn in my up-to-date clearances and help weekly in a Sunday School class

I am willing to turn in my up-to-date clearances and help as a Sunday School substitute

I am not able to help.

Please type your name to serve as a digital signature: *

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