REGISTRATION FORM

(please circle one)       Nursery    Kids Church   Sunday School   Super Church                                   

Child’s name: __________________________________________________                                         

BIRTHDATE:_________________________________Grade:____________                                                       

ADDRESS: ___________________________________________________             

  City: _____________________________State: ________________Zip___________

  Phone: ___________________________________E-mail___________________

  Father: ________________________________Mother______________________

  Church Affiliation___________________________ List any allergies or learning problems                                                                                     we need to be aware of:

CHURCH ON THE SOUND
335 Oxhead Rd, Stony Brook, NY
631-941-4100                                                 Please list all siblings and birthdates on back. Thank you.

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