Parent/Guardian Name
E-mail Address
Cell Phone
Home Phone
Home Address
City
State
Zip
Second Parent/Guardian Name
Emergency Contact (Name, Phone, Relationship to family)
I give Winnetka Congregational Church of Winnetka, IL, permission to use images, music, video and/or vocal performances of my child(ren) and grant the Winnetka Congregational Church all rights to use these sound, still, or moving images as content on its website and/or social media pages operated by Winnetka Congregational Church.
Child's Name
YesNo
1st Child/Youth Information
Birthdate
Grade for the 2021-2022 School Year
Medical or Developmental Concerns or Other Notes About Things You Think We Should Know:
2nd Child/Youth Information
3rd Child/Youth Information
4th Child/Youth Information
Would you be willing to Volunteer for Children and Youth Activities?
Yes! Sign me, parent 1, up!Yes! Sign parent 2 up!Yes! Sign both parents up!It's not the right time for us.Maybe, add me to the email list of volunteers and I will let you know.
Would your Child like to Volunteer with...
Call to Discipleship ReadingAcolytingNursery or Church School (ages 13+)Not interested at this time
