First Congregational Church of Southington Church School & Nursery Registration Form
2021-2022
Child Information
How many children are you registering?
*
Please Select
1
2
3
4
Please register all of your children, ages birth through grade 8 on this form.
First Child
Child's Name
*
First Name
Last Name
Child's Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
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12
13
14
15
16
17
18
19
20
21
22
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25
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27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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1981
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1979
1978
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1975
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1972
1971
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1969
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1966
1965
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1963
1962
1961
1960
1959
1958
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1954
1953
1952
1951
1950
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1948
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1946
1945
1944
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1942
1941
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1939
1938
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1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Current Grade
*
Please Select
Nursery (I/T)
Pre-K
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.
*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release First Congregational Church of Southington from liability in acting on my behalf in this regard.
*
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Second Child
Child's Name
*
First Name
Last Name
Child's Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Current Grade
*
Please Select
Nursery (I/T)
Pre-K
Kindergarten
Garde 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.
*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release First Congregational Church of Southington from liability in acting on my behalf in this regard.
*
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Third Child
Child's Name
*
First Name
Last Name
Child's Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Current Grade
*
Please Select
Nursery (I/T)
Pre-K
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.
*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release First Congregational Church of Southington from liability in acting on my behalf in this regard.
*
Type in initials above.
Special Concerns:In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Fourth Child
Child's Name
*
First Name
Last Name
Child's Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Current Grade
*
Please Select
Nursery (I/T)
Pre-K
Kindergarten
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Please choose Nursery (I/T) for children under the age of 3
Medical Information: Please list any allergies and/or other health concerns.
*
In case of an emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give FCCS my permission to act on my behalf in seeking emergency treatment for my child in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I release First Congregational Church of Southington from liability in acting on my behalf in this regard.
*
Type in initials above.
Special Concerns: In order to provide the best church school experience we can for your child, please use the space below to make us aware of any special needs your child(ren) may have. You can also discuss any concerns you may have directly with the Director of Christian Education. All information is held in confidence and shared only with classroom teachers & volunteers with permission.
Parent/Guardian Contact Information
Parent/Legal Guardian Name 1
*
First Name
Last Name
Contact Phone Number 1
*
Contact Email 1
*
example@example.com
Contact Address 1
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the address above the same as the child(ren).
*
Yes
No
Parent/Legal Guardian Name 2
First Name
Last Name
Contact Email 2
example@example.com
Contact Phone Number 2
Contact Address 2
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the address above the same as the child(ren).
Yes
No
Are there any persons to which the child (children) may NOT be released to?
*
Yes
No
Who may you child (children) NOT be released to?
Emergency Contact 1 (other than parent/guardian listed above)
*
First Name
Last Name
Emergency Contact 1 Phone Number
*
Relationship to child(ren)
Emergency Contact 2 (other than parent/guardian listed above)
First Name
Last Name
Emergency Contact 2 Phone Number
Relationship to child(ren)
Media Release
In order to share the good news of the mission and ministry of First Congregational Church of Southington, we occasionally use images (photo/video) of students in classrooms or during special programs, or sent to FCCS by parents/guardians. These images may be shared on church bulletin boards, newsletters, in local newspapers or other printed materials, on our website, social media (email communications, live-stream events, Facebook, Instagram, YouTube, etc.), or in presentations during worship. If you are comfortable with the use of your child(ren)’s and/or youth(s)’s images for these purposes, please indicate below.
I hereby give permission for First Congregational Church of Southington to take and use images of my child(ren)/youth (photo or video) taken during church-related activities, or shared by me with FCCS staff, for church purposes only as described above. No children/youth will be identified by name. I understand that I will be contacted for special permission should any photo be considered for use other than described above.
*
I Agree
I Disagree
Parent/Guardian Covenant
I understand that many volunteer hands are needed. I covenant to use my gifts in some way this program year to support the Church School & Nursery of FCCS. As a partner in this ministry, I pledge to uphold and support my child’s involvement in all aspects of participation including supporting the Church School teachers in their efforts to teach this year.
Choose all that apply. I am interested in:
Church School teacher
Classroom helper
Serving on the Board of Christian Education
Submit
Should be Empty: