REGISTRATION - Spring Hill Church of Christ

Child's Name*

First Last

Please tell us your Child's Gender*

Boy
Girl

Child's Date of Birth*

Name of Parent/Guardian

First Last

Parent/Guardian's Address*

Street Address Address Line 2 City State ZIP Code

Parent/Guardian's Phone Number*

Relationship to Student*

Parent/Guardian's Preferred Email

Enter Email Confirm Email

Name of Alternate Emergency Contact

First Last

Alternate Emergency Contact Number

Relationship to Student*

Child & Parent/Guardians

All reside at the same address
Do not all reside at the same address

2nd Address

Street Address Address Line 2 City State ZIP Code

We do not ask for or assume knowledge of custody situations. Please fill out this 2nd address if the child's parents live separately.

Additional Important Information (read info below box)*

Any allergies/medications your child is allergic to; Medications your child is taking; Physical or mental conditions; Illnesses or chronic conditions; Anything else Tuesday School should be aware of in regard to your child.

Is there anything that your child may not have as a snack or drink?

Is there any activity in which your child should not engage?

Please provide a list of adults who are allowed to pick up your child and their relationship:

When one of those listed are picking up your child, please send a note prior to the pick up stating who will be picking your child up and what the date of pick up will be.

Emergency Treatment Consent - Read carefully below*

I agree

I give my consent for the Spring Hill Church of Christ Tuesday School staff to provide emergency treatment for my child in the event of an accident, injury, or serious health condition occurring while at the school. Every attempt will be made to contact the guardian/emergency contact. If contact to a parent, guardian, or emergency contact cannot be made, child will be transported to the nearest hospital for emergency treatment at your expense for the treatment.

Name of Parent/Guardian Completing Form*

First Last

Date of Form Submssion*

*Please make your $70 check payable to "Spring Hill Church of Christ" and mail it to the following address:

Tuesday School c/o
Spring Hill Church of Christ
2021 Brell Drive
Middletown, Ohio 45042

Or just bring the check/cash with you to the Open House or the first day of class.

Tuesday School Registration Fall 2025