Child's Name *

First Name

Last Name

Child's Gender *

male

female

2nd Child's Name

First Name

Last Name

Child's Gender

male

female

3rd Child's Name

First Name

Last Name

Child's Gender

male

female

Parent 1 Name *

First Name

Last Name

Parent 2 Name

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home phone *

(###)

###

####

parent 1 Cell Phone

(###)

###

####

parent 2 Cell Phone

(###)

###

####

Child's phone

(###)

###

####

Emergency Contact (non-parent)

First Name

Last Name

Emergency Contact Phone (non-parent)

(###)

###

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Photo Permission

I give St. John's Lutheran permission to use photos of my child for ministry purposes.

Medical Treatment Permission *

I give the leaders of St. John's Sunday School permission to medically treat my child both in house and at a medical center if the need should arise. And I know I will be contacted as soon as possible should this happen.