Register Your Student Please complete a form FOR EACH STUDENT you are registering: Student Name* First Last Date of Birth* MM DD YYYY Student Current Age/Grade for 2019-2020 School Year*Nursery (birth - 3yrs)Early Primary (4yrs - 5K - 6K)1st2nd3rd4th5th6th7th8th9th10th11th12thStudent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Student Age as of August 31, 2019*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.*Does your child have any allergies? Please list the allergy, cause and effect, and what immediate treatment is necessary. Note: snacks may be given.*Father's Name First Last Father's Cell PhoneMother's Name First Last Mother's Cell PhoneGuardian Name (if applicable) First Last Guardian Phone (if applicable)Parent/Guardian Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent/Guardian Email What is the best way to reach you?* Select All Text Phone Call Email Consent to Photograph*I agreeI disagreeBy 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.Verification* By checking the box, I certify that I am at least 18 years of age and I am the child's parent or legal guardian.
