Immanuel Lutheran After School Tutoring
Please answer the following questions to register your child or children for Immanuel's After School Tutoring program. Feel free to attend our Open House August 24th from 3pm - 6pm.

If you have more than one child attending, please fill out a separate form for each one. Thank you!
Email address *
Your Name (First, Last) *
Your answer
Phone Number *
Your answer
Address *
Your answer
Child's Name (First, Last) *
Your answer
Child's Age *
Your answer
I would like to register my child for tutoring for the following days: *
Please list any of your child's food allergies or medical concerns that our staff and volunteers should be aware of. (If none, type none.) *
Your answer
Every activity sponsored by Immanuel Lutheran is adequately supervised; however, unforeseen events can occur. By checking the box below, the parent or guardian agrees to assume an accept all risks and hazards in related activities. Parents/guardians also agree not to hold Immanuel Lutheran, its employees and volunteers liable for damages, losses or injuries to the person or property undersigned. This agreement is for both medical and liability release.I hereby give permission for my child to be filmed or photographed by Immanuel Lutheran Church. *
Required
How did you hear about Immanuel's After School Tutoring program? Check all that apply. *
Required
Do you and your family attend a church? *
If yes, what church do you attend?
Your answer
Would you like to learn more about other opportunities at Immanuel Lutheran, Whitestone for youth and families? *
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