Register Your Student Please complete a form FOR EACH STUDENT you are registering: Student Name* First Last Date of Birth* MM slash DD slash YYYY Student Current Age/Grade for 2021-2022 School Year*Nursery (birth - 3yrs)Early Primary (4yrs - Pre-K)Kindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thStudent Address* 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.*Does your child have any allergies? Please list the allergy, cause and effect, and what immediate treatment is necessary. Note: snacks may be given.*Parent/Guardian Name* First Last Relationship to Student* (father, mother, grandparent, etc...)Parent/Guardian Cell Phone*Parent/Guardian Name First Last Relationship to Student (father, mother, grandparent, etc...)Parent/Guardian Cell PhoneParent/Guardian Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Parent/Guardian Email 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.
