Registration for STARS Spiritually Teaching And Reaching Students Wednesday After School Program2024-2025 First Child * First Name Last Name Male or Female * Child 1 Male Female Birthdate * Child 1 MM DD YYYY School * Grade for '24-'25 * Kindergarten First Second Third Fourth Fifth Allergies or Conditions Second Child First Name Last Name Male or Female Child 2 Male Female Birthdate Child 2 MM DD YYYY School Grade for '24-'25 Kindergarten First Second Third Fourth Fifth Allergies or Conditions Third Child First Name Last Name Male or Female Child 3 Male Female Birthdate Child 3 MM DD YYYY School Grade for '24-'25 Kindergarten First Second Third Fourth Fifth Allergies or Conditions Fourth Child First Name Last Name Male or Female Child 4 Male Female Birthdate Child 4 MM DD YYYY School Grade for '24-'25 Kindergarten First Second Third Fourth Fifth Allergies or Conditions Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Parent 1 Name * First Name Last Name Parent 1 Phone * (###) ### #### Parent 1 Email * Parent 2 Name First Name Last Name Parent 2 Phone (###) ### #### Parent 2 Email Additional Person Authorized to Pick Up Child(ren) First Name Last Name Phone (###) ### #### Additional Person Authorized to Pick Up Child(ren) First Name Last Name Phone (###) ### #### Additional Person Authorized to Pick Up Child(ren) First Name Last Name Phone (###) ### #### Additional Person Authorized to Pick Up Child(ren) First Name Last Name Phone (###) ### #### STARS and First Reformed Church have permission to photograph or video my child(ren). These photos may be released for use on church website or local media for promotional and informational purposes * Yes No Date MM DD YYYY I give permission for staff of STARS to provide emergency medical treatment to my child(ren) if necessary. * Electronic Signature required to successfully submit Date MM DD YYYY Other Information Thank you! You will receive an email with more information prior to the kickoff day. If you have any questions, please email annettefrcsully@gmail.com or call (641)521-4124.
