Name             Grade

Address

Birthday  Month                       Day              Year

E-mail:

  Mother's Name(or legal guardian)                                                                           Cell

  Father's Name(or legal guardian)                                                                        Cell

Alternate Pickup: 

      Emergency Contact:

     

        Allergies, Medical Needs or Special needs (please be detailed)

 

         

     Shirt Size

    May we have permission to photograph your child and use your child's photograph in any and all forms of New Covenant  

  Christian Church publications (i.e. Church websites, brochures, newsletter etc.)

 

 

 

3 yrs4yrsPre-KKindergarten1st2nd3rd4th

Jan.Feb.MarchAprilMayJune JulyAug.Sept.Oct.Nov.Dec.

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Name / Phone Number:

Name / Phone Number:

SMLXLASAMAL

yes

no

Sing With Group only Solo/ensemble

Speaking Part

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