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Wonderful Wednesday Registration Form
Please provide us with the following information.  We look forward to serving your family! 
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Child's Name *
Child's Birthdate *
MM
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DD
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YYYY
Child's Grade Level *
Child's Allergies - if none, please type N/A *
Child's Name (2)
Child's Birthdate (2)
MM
/
DD
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YYYY
Child's Grade Level (2)
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Child's Allergies (2) - if none, please type N/A
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Address *
Parent/Guardian Phone Number *
If someone other than the person above will be picking up your child(ren) from Wonderful Wednesdays, please provide that alternate pick-up information below, to include the person's name and phone number.
I give permission to photograph and post pictures of my child(ren) to the Gloria Dei Lutheran Church website and/or Facebook page. *
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