Please submit the information below prior to the first Sunday your child attends Sunday school. Please submit once for each child.

Student Information

Child's name:
Gender:
Grade:
Birthdate:
Allergies:

Has your child been issued an epi-pen?

Yes No

If yes, please complete the Consent for Emergency Medication Administration form.


Parent Information

Parent #1's Name:
Address:
City, State, Zip:
Home Phone:
Cell Phone:
Email:
   
Parent #2's Name:
Address:
City, State, Zip:
Home Phone:
Cell Phone:
Email:
   
Please list any other important information we should know about your child:

Photo/Video Release

I understand that by participating in Sunday School and its associated activities, my son/daughter will be photographed and videotaped. I hereby assign and authorize the producer, Westminster Presbyterian Church, the rights (all rights) in and to such videotape and photography. I also authorize said producer, without limitation, the right to reproduce, copy, exhibit/publish, and distribute any such videotape and/or photographs, and expressly waive any rights or claims I may have against Westminster and/or any of its Affiliates, Subsidiaries, or Assignees except as outlined in this contract.

May we publish photographs of your child in print?

May we publish photographs of your child on our website?

May we video your child and upload videos to our website?

Students will not be identified by name in any of these publications.