Westworth United Church
Sunday School Registration Form
2021 / 2022
Child’s First Name:
Child’s Last Name:
1. Child’s Birth Date (Month/Day/Year):
Child’s Preferred Pronouns:
Child’s Grade Level in the 2021/2022 School Year:
Full Name of Parent(s)/Guardian(s):
Home Telephone Number:
Home Address:
Postal Code:
Parent/Guardian Email Address:
Is your family new to Westworth Sunday School?:
Names and ages of other children in the family attending Westworth Sunday School:
Emergency Contact During Sunday School Hour:
Please list any food allergies:
Please list any non-food allergies:
Does your child have asthma?
If your child has asthma, what could trigger an attack?
Does your child have any difficulty in:
What kinds of strategies work well with your child when difficulties are experienced?:
Does your child have any medical problems? (i.e. diabetes, ADD, ADHD, etcetera):
Can we contact you if we have specific questions?:
Signature: By typing your name below, you are signalling that the information above is true and you are authorizing Westworth United Church to retain this information while your child is enrolled in Westworth Sunday School.
