CONFIRMATION REGISTRATION
Please fill out this form with as much detail as possible. This information will only be used to help organize the class and to notify families of any upcoming events or emergencies
Email address *
Student Name (First, Last, Middle initial) *
Your answer
What do they prefer to be called, what pronouns are acceptable. *
Your answer
Birthdate (MM/DD/YYYY) *
Your answer
Age of Student *
Your answer
School Grade Fall 2019 *
Your answer
Student's Primary Address *
Your answer
Parents/Caregiver *
Your answer
Primary Phone Number *
Your answer
Student lives with this person *
Required
Relationship to the student *
Required
If you answered part-time, please list the name, of the other parent or caregiver.
Your answer
Student' Secondary Address (if applicable)
Your answer
Secondary Phone Number - is this number willing to receive texts (please include area code)
Your answer
Student lives with this person
Relationship to the student
Special Needs of the Student (dietary, health, etc.) *
Your answer
Allergies *
Your answer
We cannot do this ministry without the help of the adults in the students lives. We have several opportunities to volunteer throughout the year. Please check the boxes in the areas you wish to volunteer. *
Required
We recognize that extra curricular engagements are a vital part of most youth's lives. Please let us know a little bit about your child's extra curricular activities. What organized activities does your child participate in. Do you foresee extra curricular activities impeding your child's attendance at Transit classes and related activities? What can we do to help with this? *
Your answer
Parent Release: I consent to allow the above person's participation in the ministries of Peace Lutheran Church, consent to medical treatment in the case of an emergency and, in the event of disruptive behavior to the rest of the class, agree to pick up the person upon notice. *
Required
I consent to my child's image, voice or likeness to be used in promotional pieces on behalf of Peace Lutheran Church in media, multi-media, social media, website or other forms. *
Required
Other information to be shared with Pastor Brad and Peace Lutheran Church *
Your answer
THANK YOU FOR FILLING OUT THE REGISTRATION FOR TRANSIT AT PEACE LUTHERAN CHURCH
If you need to contact Pastor Brad, you can do so by email at pastorbrad@peaceoshkosh.org or you can call/text him at 701-570-1843
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