2021-2022 FLC Children's Ministry Registration
Welcome to Children's and Family Ministry at First Lutheran Church, Cedar Rapids, IA! Thank you for completing this form in preparation for the 2021-2022 program year. It helps us to know who to expect and that we have the most accurate information for your family. Please fill out ONE form per household.
Household Last Name *
Household Address *
Phone #1 *
Phone #2
Email Address *
Parent/Guardian Name/s *
Child 1 Name *
Child 1 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.) *
Child 1 Birthdate *
MM
/
DD
/
YYYY
Child 1: Medical/Allergy or Other Important Information for this child
Child 2 Name
Child 2 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.)
Child 2 Birthdate
MM
/
DD
/
YYYY
Child 2: Medical/Allergy or Other Important Information for this child
Child 3 Name
Child 3 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.)
Child 3 Birthdate
MM
/
DD
/
YYYY
Child 3: Medical/Allergy or Other Important Information for this child
Child 4 Name
Child 4 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.)
Child 4 Birthdate
MM
/
DD
/
YYYY
Child 4: Medical/Allergy or Other Important Information for this child
Who can pick up this child/these children from their classroom?
First Lutheran Church Member? (You don't have to be!) *
Submit
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