Please complete a separate form for each child you would like to register.
There will be a link back to this form after submission.
Child Information
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Age *
What grade will your child be entering in the fall?
Contact Information
Parent and Emergency Information
Mother's Name
First & Last
Your answer
Father's Name
First & Last
Your answer
Street Address *
Your answer
City *
Your answer
Home Phone Number *
Your answer
Cell Phone Number
Your answer
Email Address *
Your answer
Emergency Information
Emergency Contact Person *
contacted in case parent can not be reached
Your answer
Emergency Contact Phone Number *
used in case parent can not be reached
Your answer
Food Allergies *
List all food allergies
Your answer
Medical Concerns or Limitations *
List all medical concerns
Your answer
Please list all people with permission to pick up this child. *
Your answer
Church Information
Do you attend a church? *
Name of church you attend
Your answer
Does Emmanuel have permission to photograph/ film the minor listed above? *
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This form was created inside of Emmanuel Lutheran School.