New Student Information Form

Father's First Name

Father's Last Name

Father's Phone Number

Mother's First Name

Mother's Last Name

Mother's Phone Number

Child's First Name

Child's Last Name

Birthdate

Allergies

Toilet Training Status

Picture/Photo Use: Journey Church of Atlanta may use photos of children for promotional materials. Identifying information is not shared. Do you give permission for your child’s image to be used online and in print advertisements and promotions?

Yes

No

Do you have any additional children to add?

Yes

No

Signature

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