2009 – 2010 Church School & Confirmation Registration Form

Seekonk Congregational Church

United Church of Christ

600 Fall River Avenue, Seekonk, MA 02771

CHILD'S NAME:___________________________________________________________________________

(First) (Middle) (Last)

DATE OF BIRTH:____________________________

BAPTIZED:       _____YES         _____NO

PARENTS' NAMES_________________________________________________________________________

Address __________________________________________________________________________________

City/State________________________ Zip Code___________

Telephone:( ) ______________________

Church School Session (circle one) 9AM 10:30 AM

Entering in September 2009 (circle one):

Nursery (Birth to 3YR) Preschool 3 YR / 4YR Kindergarten

(circle one): 1^st 2^nd 3^rd 4^th 5^th 6^th 7^th 8^th

PARENT'S EMAIL ADDRESS ________________________________________________________________

Confirmation Class (9th grade or above)

EMAIL ADDRESS OF CONFIRMAND _____________________________________________

Medication/Allergies/Special Needs (please notify us) ______________________________________________

(If additional space is need please use back of this form)

Church Activity/Interests (Please check any that your child would participate in)

______ Sacred Dance _______ Play Musical Instrument

______ Bells/Tone Chimes _______ Drama

______ Children’s Choir (K-5)   _______ Acolyte

______ Youth Choir (6-7-8) _______ Other ___________________________

If you have additional concerns or helpful information, please use back