Sunday School Registration Form

St. Luke's Lutheran Church

365 W. River Road

New Richmond, WI 54017

715.246.4861
Sunday School Registration Form

Child #1 Information
Child's Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Age*
Grade Entering*
School District *
Baptism Date

MonthDayYear
List Allergies

Child #2 Information
Child's Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Age
Grade Entering
School District
Baptism Date

MonthDayYear
List Allergies

Child #3 Information
Child's Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Age
Grade Entering
School District
Baptism Date

MonthDayYear
List Allergies

Child #4 Information
Child's Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Age
Grade Entering
School District
Baptism Date

MonthDayYear
List Allergies

Parent/Guardian Information
Parent #1 *

First NameLast Name
Parent #1 Cell Number*
Please enter a valid phone number.
Parent #1 Email Address*
example@example.com
Parent #2 (Optional)

First NameLast Name
Parent #2 Cell Number
Please enter a valid phone number.
Parent #2 Email Address
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Are you a member of St. Luke's Church?
Yes or No
If not, what is your church affiliation?

Emergency Contact Information
Emergency Contact*

First NameLast Name
Emergency Contact Cell Number*
Please enter a valid phone number.
Relationship to Child*
ex. Father, Mother, Grandparent, etc.

Parents: Check if interested in helping with any of the following:
Check if you are interested in helping with any of the following youth activities?

TeachingSnacksMusicChristmas ProgramVBSWednesday Family NightsTechnology + Sound BoardArt/Crafts
Questions / Suggestions / Comments
St. Luke's Church and Sunday School leaders have permission to photograph/film the minor designated above in any manner or form for any lawful purpose associated with promoting St. Luke's yough programs.
Type name to agree to the above:
Name
Date

MonthDayYear
Date
Should be Empty: