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Midweek Registration
Midweek resumes on September 15th at 6pm - meal at 5:45pm, if COVID protocol permits.
Please fill out the following information for each child you are registering.
If you have any questions, please contact the church office at 636-937-5525.
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Parent/Guardian Name(s)
*
Your answer
Email
*
Your answer
Address
*
Your answer
Phone number
*
Your answer
I give permission for Immanuel Lutheran to take and use photographs or electronic media images for print publications, online publications and social media of my child(ren).
*
Yes
No
In the event of injury or illness, every effort will be made to contact the parent or guardian. If necessary, I authorize ILC to administer first aid and/or authorize medical treatment.
*
Yes
No
Child's Name
*
Your answer
Age
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Grade for 2021/2022
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Your answer
Any known allergies
Your answer
Child's Name
Your answer
Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade for 2021/2022
Your answer
Any known allergies
Your answer
Child's Name
Your answer
Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade for 2021/2022
Your answer
Any known allergies
Your answer
Child's Name
Your answer
Age
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade for 2021/2022
Your answer
Any known allergies
Your answer
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