Immanuel School and Early Childhood Registration Form
Please input all information for registration. Someone from the office will contact you after your information is received to set up a meeting time.
Todays Date *
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Grade enrolling in: *
Student's Name *
Your answer
Student's and Family Address (street, city, state, zip) *
Your answer
Student's Date of Birth *
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Student's Place of Birth *
Your answer
Student's Age *
Your answer
Student's Gender *
Your answer
Student's Date of Baptism
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Student's Denomination (Church Affiliation)
Your answer
Families Home Phone
Your answer
School District Child resides in: *
Students Father's name *
Your answer
Students Father's Address (Street, City, State, Zip - If Different than Student's)
Your answer
Students Father's Phone
Your answer
Students Father's Occupation and Employer
Your answer
Students Father's Work Phone
Your answer
Students Father's Cell Phone
Your answer
Students Father's Church membership
Your answer
Students Father's email
Your answer
Students Father's Marital Status
Students Mother's Name *
Your answer
Students Mother's Address (Street, City, State, Zip - If Different than Student's)
Your answer
Students Mother's Home Phone
Your answer
Students Mother's Occupation and Employer
Your answer
Students Mother's Work Phone
Your answer
Students Mother's Cell Phone
Your answer
Students Mother's Church Membership
Your answer
Students Mother's Email
Your answer
Students Mother's Marital Status
If Divorce or Separation, with whom is the child living (please give Name, Phone Number, Address, and Relationship to Student)
Your answer
Stepparent's Name
Your answer
Stepparent's Address (if different than above)
Your answer
Stepparent's Home Phone
Your answer
Stepparent's Cell Phone
Your answer
Stepparent's Occupation and Employer
Your answer
Stepparent's Work Phone
Your answer
Stepparent's Email
Your answer
Stepparent's Name
Your answer
Stepparent's Address (if different than above)
Your answer
Stepparent's Home Phone
Your answer
Stepparent's Cell Phone
Your answer
Stepparent's Occupation and Employer
Your answer
Stepparent's Work Phone
Your answer
Stepparent's Email
Your answer
Other Children in the Family and Date of Birth
Your answer
What is your child's shirt size *
What is your child's shirt size *
How did you hear about Immanuel Lutheran School *
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