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Last updated: January 12, 2007
CPC Christian Education Registration and Behavior Agreement Form Child's Name (First, M.I., Last) ___________________________________________ Date of Birth ____/____/_____ Grade in School _____ Baptized? Y N Parents'/Guardian's Name(s) ____________________________________________ Street Address _______________________________________________________ City ______________ State ____ Zip __________ Willing to Help in Class? Y Tel No. _________________ Emergency or Cell Phone No. _________________ Medical Ins. Company __________________________ Policy No. ____________ Group/Member No. ____________________________ Allergies or Other Medical Conditions ___________________________________ ___________________________________________________________________ My child and I have read and accept the Classroom Covenant. Parent's/Guardian's Signature __________________________________ Date ____________________
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Please print the form above and return the completed form to the Church office (Attn: Christian Education). One form per child is required.