Tusculum Church of Christ - Tusculum Kids Information Form

Tusculum Kids Information Form

Help us know how best to serve your family. In case of an emergency, this information also helps us know whom to contact.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Phone Number

Parent/Guardian Email

Second Parent/Guardian First Name

Second Parent/Guardian Last Name

Phone Number

Email

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

First Name

Last Name

Gender

Birthdate

Grade

Allergies

Please list any other medical concerns

"I give permission to take my child(ren)'s picture/video for classroom projects"

Yes

No

"I give permission to take my child(ren)'s picture/video for the church website/social media"

Yes

No

Anything else you'd like us to know?

Signature