Sunday School/Catechesis Registration Form

Safety Policy (Parent/Guardian remains on-site).

All clergy, staff, and C&Y volunteers are trained in Safe Church policies, as required by the Diocese of Virginia. Maintaining these policies helps provide a safe environment for the children of the church, as well as our staff and volunteers. Please direct any questions about this to Rev. John at jshellito@saintgeorgeschurch.org . Please note that Saint George’s Catechesis, Nursery, and Sunday School are not a licensed childcare provider. By registering my child(ren) for Sunday Activities I/we acknowledge that at least one parent/guardian will remain on the premises of Saint George’s Church while children are attending programs, as required by law for non-licensed facilities. Children will be asked to leave the program if parents do not follow this requirement.

REGISTER YOUR CHILD FOR SUNDAY ACTIVITIES IWord Doc)

Child/Children's Names

First Name

Last Name

Age and Birthdate

Grade

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Special Accommodations Needed:

Other information you want teachers to know

Are you willing to assist teachers in the classroom

Yes

Parent/Guardian 1

Phone - Parent/Guardian 1

(###)

###

####

Email Address - Parent/Guardian 1

Parent/Guardian 2

Email Address - Parent/Guardian 2

Phone - Parent/Guardian 2

(###)

###

####

Emergency Contact

Emergency Contact phone

(###)

###

####

Emergency Contact Email

Family Doctor

Family Doctor Phone

(###)

###

####

Family Dentist

Dentist Phone

(###)

###

####

Health Insurer

Group Number

Policy Holder Name

Policy Number

Food/Drug Allergies

Prescription Medications

Photographs and Emergency Medical Authorization

St. George’s Episcopal Church has occasionally taken photographs of our members in fellowship and in other special events, as a celebration of our common life together and also, as a way to introduce newcomers to the life of the church. St. George's asks that you grant your permission for photographs of the above named child to be published without names attached, including on our website and in other promotional materials. We will never include names of children or adults in photos on our public website or in other public materials. If you do not want to grant permission to St. George's, you can check "no" on this online form, or you can fill out our Photo Opt-Out form, and turn it into the Parish Office.

Yes

Authorization for Emergency Medical Treatment

As the parent/guardian of the above named child(ren), should a medical emergency arise during my child’s participation in a St. George’s-sponsored activity, I understand that reasonable efforts will be made to contact me or my designated alternate at the phone numbers listed above. If it is believed that my child’s life or health could be adversely affected by the delay that an attempt to contact me or my designated alternate would cause, I consent to emergency medical treatment for my child in my absence. This authorization extends to my child’s participation in any activity sponsored by St. George’s Church, Arlington, VA.

Yes

Optional Information for St. George’s database

We’d be interested to know any additional information you are comfortable sharing about your spiritual journey. For example, the locations and dates of any Baptisms, Confirmations, or other significant faith milestones are often helpful and important if that information is available. St. George’s is strengthened by its diversity and inclusiveness, as we all seek to embody God’s lovingkindness, together.

Sunday School/Catechesis Registration Form

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