Zion United Church of Christ
Sunday School Registration

Date:__________________________

Name:___________________________________             Age________

Street address:____________________________________________

City:__________________________State:____________Zip:________

Home telephone:_____________________

Home e-mail:_________________________________________

Date of Birth:___________________

Grade in school:______________

In case of emergency, contact:

Mother:_____________________________

 	Phone or Cell:___________________

Father:______________________________
 
Phone or Cell:__________________

Other:_______________________________ 

	Phone:_______________________ Cell:___________________________

Allergies or other medical conditions_____________________________

_______________________________________________________________________