Child's Name
Parent's
Address:
City:
State:
Zip:
E-mail:
Home Phone:
Cell Phone:
Age/Birth date
Last School grade completed (for children)
Do you go to Sunday School?/ Where
Medical, allergy, or other information we need to know:
Emergency Contact
Who may pick up this child?
Additional Comments:

If you have any Questions call Mike Wehn, Director of Christian Education at 442-4077 or
email at bellevue@epix.net

or mikewehn@frontiernet.net