St. John's Lutheran Church - Confirmation Registration

312 S 3rd Street, Evansville, WI 53536
Confirmation Registration: 2026-2027 School Year
Participant Information*
Home Church (if not St. John's)
Photo Release: I give permission for still or video photographs of my child(ren) to be taken by St. John's Lutheran Church for internal documentation and for use on the church's website, Facebook page, and other published materials.*

YesNo
Parent/Guardian Information
Parent/Guardian's Name*

First NameLast Name
Partner's Name
Phone Number*
Format: (000) 000-0000.
Receive Texts?*

YesNo
E-mail*
jonesfamily@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian's Name

First NameLast Name
Partner's Name
Phone Number
Format: (000) 000-0000.
Receive Texts?

YesNo
E-mail
jonesfamily@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any additional information needed to help us better communicate with you and those involved in your child's faith journey.
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Medical Release

I hereby give my approval for my child’s participation in any and all activities prepared by St. John's Lutheran Church. In case of injury I give permission for the St. John's leaders to administer basic first aid to my child(ren). I understand that St. John's leaders will contact emergency services in the event of a significant injury, and I am responsible for any and all expenses for such emergency services.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*
Should be Empty:

Confirmation Registration: 2026-2027 School Year