St. John's Lutheran - Christian Education Registration Form
Please fill out completely and if there are any questions, please contact chrystalrasmussen@stjohns-annandale.org
Family Last Name *
Your answer
Parents/Guardians: *
Your answer
Address *
*If there is more than one address, please list both*
Your answer
Home Phone Number *
Your answer
Dad's Cell Number and Email Address *
Your answer
Mom's Cell Number and Email Address *
Your answer
For each child, please fill out the following information (each child should have their own box) *
First and Last Name, Date of Birth, Grade (even for Sunday School), Registering for Sunday School or D-Way, and any Special Needs (hearing, speech, food allergies, reading, ADHD, or other info needed to create the best learning environment for your child).
*
Child #1
Your answer
Gender *
Grade *
Your answer
Child #2
Your answer
Gender
Grade *
Your answer
Child #3
Your answer
Gender
Grade *
Your answer
Child #4
Your answer
Gender
Grade *
Your answer
Emergency Contacts *
Please list 2 emergency contacts along with their phone numbers:
Your answer
Medical Information *
Please list your Insurance Company and Policy Number along with your preferred hospital
Your answer
*
By typing my name below, I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in case of an emergency.
Your answer
Photo Release 2017-2018 *
By typing my name below, I, as a parent/guardian of the child(ren) listed above, do hereby agree to appear/have them appear in photographs of St. John’s Lutheran Church activities and agree to have my likeness/child(ren)’s likeness used by St. John’s and it’s agents for the purpose of public relations, advertising and general publicity for the church including, but not limited to, digital, video and audio reproduction of my likeness/my child(ren)’s likeness.
Your answer
We have volunteer opportunities in Sunday school and DWAY. Would you like to volunteer?
Behavior Policy *
In order for our Christian Education classes to be a great experience for all, it takes cooperation from everyone. Each person contributes to the attitude and the experience of the group. Because of this, exclusive cliques or relationships, negative attitudes, disrespect (towards self, others, or building), inappropriate behavior, and rebellious spirits are not acceptable. They should come ready to participate fully in the scheduled activities and demonstrate good behavior. If these behaviors are not followed, discipline will be taken. The discipline policy can be found in the handbook. By typing my name below, I understand and agree to support our behavior and discipline policies, in regards to my child(ren)’s behavior while at St. John’s.
Your answer
Evening Meals *
Evening Meal: We will be offering pizza (from Jimmy's), veggies, beverage and a dessert for a set amount each week. You have the option to pay $40 in advance or pay as you go. $2.00 per meal will get you 1 slice of pizza, veggies, beverage, and 1 dessert. Additional slices of pizza will be $1.00 per slice. Please indicate if you are interested in purchasing the meals upfront and send your $40.00 payment to the office.
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