Monday School Registration

We are pleased that you are interested in enrolling your child for the 2015-2016 school year.  Please fill out all of the information listed below.

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* Required information.
Child's First and Last Name *
Child's Age *
Child's Date of Birth (yyyy/mm/dd) * 1000
Street Address *
City *
State
Zip Code
Parent(s) / Guardian Name(s) *
Telephone Number *
Emergency Contact Person *
Emergency Contact Telephone # *
Who is authorized to pickup your child? *
Does child have any allergies?
If yes, tell us what your child is allergic to?
Is there any other medical history we need to be aware of?
Do you currently attend church? *
If yes, where do you attend? *
Comments or questions?