2021-2022 Children & Student Registration

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CALVARY LUTHERAN CHURCH.
Three years old through high school.

Directions: Complete one form for each student you give permission to engage in the ministries of Calvary Lutheran Church. Calvary Lutheran Church is required to have the following information on file. Please complete each section.

Student Name (Last, First) *

Birthday (mm/dd/yyyy) *

Grade entering school (age if preschooler): *

Name of school attending 2021/22 academic year: *

Special learning needs, allergies or medical issues:

Street Address *

City *

Zip Code *

Student Email (If applicable) *

Student Cell Number (If applicable)

Parent/Guardian Names *

Address of parent/guardian (If different from above) *

Home Phone (with area code) *

Mom/guardian Email *

Mom/guardian Cell Phone Number *

Dad/guardian Email *

Dad/guardian Cell Phone Number *

Emergency Contact Name and Phone other than Parent *

DIGITAL IMAGE RELEASE: Digital images of children and youth participants are used for educational and marketing purposes for Calvary Lutheran Church. No names are used with images. *

I permit use of digital images of my son/daughter for educational and marketing purposes.

I do not permit the use of digital images of my son/daughter.

Registering for: (Check all that apply. Note Registration fee for Confirmation) *

Children's Ministry (KidZone and other ministries for ages 3 years old through the 5th grade)

Middle School Student Ministry (Grades 6-8)

Confirmation (Grades 6-8. There is a $25 fee to offset materials.)

High School Student Ministry

Required

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