JAM Registration 2019
Registration for JAM for the 2019-2020 School year, If you have questions feel free to email Lydia Jagodzinski Children's and Youth Leader 763-222-7282(call or text) Youth@Lesueurumc.org
Child 1 Name *
Your answer
Child 1 Age *
Your answer
Child 1 Date of Birth
MM
/
DD
/
YYYY
Child 1 Grade Fall 2019 *
Your answer
Child 1 Special Needs or Allergies *
Your answer
Was your Child Baptized? *
If yes, where?
Your answer
Does your child have a Deep Blue Bible
If not Baptized would your child be interested in getting baptized this fall?
Child 2 Name
Your answer
Child 2 age
Your answer
Child 2 Grade Fall 2019
Your answer
Child 2 Date of Birth
MM
/
DD
/
YYYY
Is your child bapitzed?
If so where and what year?
Your answer
If not are you interested in getting your child baptized this fall
Parent #1 Name *
Your answer
Parent #1 Email Address *
Your answer
Parent #1 Phone *
Your answer
Parent #1 Address *
Your answer
Parent #2 Name
Your answer
Parent #2 Email
Your answer
Parent #2 Phone
Your answer
Parent #2 Address (If Differs from parent #1)
Your answer
Emergency Contact Name and Relationship to Child *
Your answer
Emergency Contact Phone Number *
Your answer
Do we have permission to use and post pictures of your child for marketing, and promotional purposes
Would you be Interested in information on how you can volunteer for JAM this fall?
Submit
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