Register Your Student

Please complete a form FOR EACH STUDENT you are registering:

Student Name(Required)

First Last

Date of Birth(Required)

Student Current Age/Grade for 2024-2025 School Year(Required)

Student Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Has your child been diagnosed with any physical or developmental disability? (Example: Diabetes, Epilepsy, ADHD, Cerebral Palsy, Autism, or any other medical condition.) Please explain below to help us understand & effectively minister to your student.(Required)

Does your child have any allergies? Please list the allergy, cause and effect, and what immediate treatment is necessary. Note: snacks may be given.(Required)

Parent/Guardian Name(Required)

First Last

Relationship to Student(Required)

(father, mother, grandparent, etc...)

Parent/Guardian Cell Phone(Required)

Parent/Guardian Name

First Last

Relationship to Student

(father, mother, grandparent, etc...)

Parent/Guardian Cell Phone

Parent/Guardian Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian Email

What is the best way to reach you?(Required)

Text

Phone Call

Consent to Photograph(Required)

By selecting "I agree," I authorize Neshannock Alliance Church ministries to photograph my child during church activities for the purpose of power point presentations, slides, bulletin board displays, scrapbooks, and/or advertisements of church events.