Children & Youth Registration
Use this form to register your child for 2018-19 programs at Redeemer Lutheran Church
Email address *
Parent Name *
Your answer
Parent Phone #
Your answer
Alternate Phone #
Your answer
Emergency Contact
Your answer
Emergency Contact Phone #
Your answer
Family Mailing Address
Your answer
Name of First Child
Your answer
Birthdate
MM
/
DD
/
YYYY
Entering which grade?
Student Cell phone?
Your answer
What Programs will they enroll in? *
Required
Allergies or Dietary Restrictions?
Your answer
Does your child have any special needs we should be aware of to help them succeed in programming? (ADD, Autism Spectrum, etc.?)
Your answer
Photo Release - please check if Redeemer has permission to use your child's photo in social media and print media.
Name of Second Child
Your answer
Birthdate
MM
/
DD
/
YYYY
Entering which grade?
Student Cell phone?
Your answer
What Programs will they enroll in? *
Required
Allergies or Dietary Restrictions?
Your answer
Does your child have any special needs we should be aware of to help them succeed in programming? (ADD, Autism Spectrum, etc.?)
Your answer
Photo Release - please check if Redeemer has permission to use your child's photo in social media and print media.
Submit
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