St. Jacobi Youth Ministry (Kids' Club and The Armory)
Registration Form for the 2021-2022 school year

- Please fill out one form per child.

*Important*
This form needs to be completed for every student enrolling in Kids' Club (4k-6th). For children in the 4k or 5k classes, the child(ren) must have reached the designated age by sept, 12th 2021.

What is your child's full name?
How old is your child?
What grade will your child be in for the 2021-2022 school year?
When is your child's Birthday?
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What school will your child attend in the fall?
Clear selection
Has your child been baptized?
Clear selection
Full name(s) of your child's parent(s) or guardian:
Parent(s) or guardian's phone number:
Parent(s) or guardian's address:
Parent or guardian's email address:
Are the Parent(s) or guardian members at St. Jacobi? If you're a member at a different church, please list it below.
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Full name of an emergency contact if a parent or guardian cannot be reached:
Emergency contact's relationship to your child:
Best phone number for this emergency contact:
Is there any special information we need to know about your child? ie. allergies, medication taken, ect...?
Is there any special information you'd like us to know about your child or your family?
By checking the "yes" box you acknowledge giving St. Jacobi Lutheran Church and its youth ministries permission to use images of your child for communication purposes in print and on digital/web-based formats. This will act as a photo release.
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