2018-2019 Children & Youth Ministry
Registration form for the 2018-2019 Gloria Dei Lutheran Church Children & Youth Ministry
Email address *
Parent/Guardian's Name: *
Your answer
Street Address: *
Your answer
City, State, Zipcode: *
Your answer
Phone Number: *
Your answer
Member of Gloria Dei *
If you are a member of another congregation, please list:
Your answer
Please List Child Name, Birth Date, and Grade Level: *
Your answer
Photo Consent:
On occasion, Gloria Dei uses photo and video on its website, social media pages, and for other church related publicity. Gloria Dei will not identify minors by name when photos are online.
Authorize Photo Use: *
By entering your name below you are confirming or declining the use of photos taken during the program that may contain your child's image: *
Your answer
Are there any special needs, medical, or health related concerns you should communicate? (such as allergies)
Your answer
Emergency Contact Information:
Name: *
Your answer
Phone Number: *
Your answer
Relationship to Children: *
Your answer
Please indicate if your child will be participating in any of the following: *
Yes
No
Would like more information
Sunday School (preschool - 4th grade)
Confirmation (5th - 8th grade)
Kids of the Kingdom Choir (2nd - 8th grade)
Cherub Choir (Ages 4 - 1st grade)
Hope Handbells (3rd grade and older)
Chime Choir (3rd grade and older)
First Communion (November 11-12)
Please indicate which area(s) you are interested in helping:
Any additional information you would like to share:
Your answer
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