*indicates a required field Parent / Guardian Information Parents / Guardian* Relationship to Child* Spouse Name (If married) Address 1* Address 2 City* State* Zip Code* Primary Phone* Additional Phone Additional Phone Type CellWorkSpouseOther 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 St. 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. Yes Child's Information: Child's Name* Current Grade* NonePreschoolKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthOther Gender* MaleFemale Birthday* Food Allergies?* YesNo List of Food Allergies: Medical Concerns?* YesNo Explain Medical Concerns: (Or continue below to add more children) Additional Children: Child's Name Current Grade NonePreschoolKindergardenFirstSecondThirdFourthFifthSixthSeventhEighthOther Gender MaleFemale Birthday Food Allergies? YesNo List of Food Allergies: Medical Concerns? YesNo Explain Medical Concerns: Click here to go to Submit button(Or continue below to add more children) Child's Name Current Grade NonePreschoolKindergardenFirstSecondThirdFourthFifthSixthSeventhEighthOther Gender MaleFemale Birthday Food Allergies? YesNo List of Food Allergies: Medical Concerns? YesNo Explain Medical Concerns: Click here to go to Submit button(Or continue below to add more children) Child's Name Current Grade NonePreschoolKindergardenFirstSecondThirdFourthFifthSixthSeventhEighthOther Gender MaleFemale Birthday Food Allergies? YesNo List of Food Allergies: Medical Concerns? YesNo Explain Medical Concerns: Click here to go to Submit button