Faith Development Registration

Student Name*
Preferred name
Birth Date*
 / 
 / 
Grade starting fall of 2021*
Any special needs, allergies, or health concerns
Student Name-
Preferred name-
Birth Date-
 / 
 / 
Grade starting fall of 2021-
Any special needs, allergies, or health concerns-
Student Name--
Preferred name--
Birth Date--
 / 
 / 
Grade starting fall of 2021--
Any special needs, allergies, or health concerns--
Parent/Guardian Name:*
Relationship (Parent/Grandparent/etc):*
Address:*
Parent/Guardian Phone:*
-
Parent/Guardian E-mail:*
Additional Parent/Guardian Name:
Additional Parent/Guardian Address (if different):
Additional Parent/Guardian Phone:
-
Additional Parent/Guardian E-mail:
I give permission for CUUC to use images of my student(s) in internal and external communications.*

To complete the registration process, please duplicate the characters below and then press "Submit" to send your information

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