Home Phone:  Other Phone:  Email:

Street:  City:  Zip:

Child's Birth Date:  Age (by 9/30/10):  Grade in School (9/10):

Baptized? Yes   No                                         Attends RLC Day School?     Yes   No

Current member of RLC?   Yes   No

If child is entering 5th or 6th grade, are you interested in Holy Communion instruction this year?  

Yes   No

Name of Adult(s) bringing child to Sunday School:  

*** NOTE: An emergency number MUST be given if adult caretaker leaves the building during Sunday School Hour!

Your name: