*indicates a required field

Parent / Guardian Information


Parents / Guardian*

Relationship to Child*

Spouses Name (If married)

Address 1*

Address 2

City*

State*

Zip Code*

Primary Phone*

Additional Phone

Additional Phone Type

Email Address

Emergency Contact (Name & Phone)

Relationship to Child

Select Children's Program*
AWANA (Wednesday Nights)Discovery Land (Sunday Mornings)Both AWANA & Discovery LandNone - Please Contact Me for More Info

I authorize Upper Saint Clair Alliance Church to use and publish photographs of my child or children, on in which my child or children may be included, in any church publication. This includes church videos, website, and other promotional materials. I hereby release the church and its employees and agents from all claims and liability relating to said photographs. I understand that if I should change my mind about this decision I may contact the church office at any time.


Child's Information:


Child's Name*

Current Grade*

Gender*

Birthday*

Food Allergies?*

List of Food Allergies:

Medical Concerns?*

Explain Medical Concerns:

(Or continue below to add more children)


Additional Children:


Child's Name

Current Grade

Gender

Birthday

Food Allergies?

List of Food Allergies:

Medical Concerns?

Explain Medical Concerns:

Click here to go to Submit button
(Or continue below to add more children)


Child's Name

Current Grade

Gender

Birthday

Food Allergies?

List of Food Allergies:

Medical Concerns?

Explain Medical Concerns:

Click here to go to Submit button
(Or continue below to add more children)


Child's Name

Current Grade

Gender

Birthday

Food Allergies?

List of Food Allergies:

Medical Concerns?

Explain Medical Concerns:

Click here to go to Submit button