Christian Education 2024-25 Registration
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Child Name *
Will Wendt
Birthdate *
MM
/
DD
/
YYYY
Age as of Sept 1, 2024 *
Current Grade (2024 25) *
Allergies/Medical Information/Other
Parent/Guardian #1 Information
Parent/Guardian #1 Name *
Parent/Guardian #1 Cell Phone #
 *
Parent/Guardian #1 Home Phone #
Parent/Guardian #1 Street Address
 *
Street
PO Box/Appt
City State Zip
Parent/Guardian #1 Email Address
 *
Parent/Guardian #2 Information
Parent/Guardian #2 Name *
Parent/Guardian #2 Cell Phone #
 *
Parent/Guardian #2 Home Phone #
Parent/Guardian #2 Street Address
 *
Street
PO Box/Appt
City State Zip
Parent/Guardian #2 Email Address
 *
Emergency Contact Information
Emergency Contact #1 Name *
Emergency Contact #1 Phone # *
Emergency Contact #2 Name *
Emergency Contact #2 Phone # *
Picking Up Your Child From Class
Parents of students PK- 4th grades MUST come into the classroom to pick up your child when class is done.  This is to ensure the safety of all children in the Program. 
Name of Person Who Will be Picking up the Child *
Phone # *
Photo Permission *
Immanuel-Trinity Lutheran Church, Fond u Lac, WI may include images on our website, brochures, or other forms of media to promote the positive activities happening at our church. Names will never be shared on the site to directly identify youth. Please indicate your preference below.
Additional Information:  Please include information such as: Anything that affects your child's learning such as fears; sensitivity to sound, light; learning difficulties etc. This information is only requested in order to enable me help your child succeed in Christian Ed classes. 
All information is confidential. 
 *
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