Mid-Week Youth

Parents of 3rd grade though 6th grade
(as of September 1, 2024).

Please register your child below

Student Name

Birthday

Month

Day

Year

Age

Grade 24-25 School Year

Street Address

City, State and Zip

Father's Name

Father's Contact Number

Father's Email

Mother's Name

Mother's Contact Number

Mother's Email Address

Allergies or Other Medical Conditions

Emergency Contact

Emergency Contact Number

Emergency Contact Relationship to Child

Person(s) Authorized to Drop off and/or Pick up Child

Permission for Photograph & Video Release - I understand St. Paul Lutheran Church will be taking pictures and videos of my child. Indicate below if you DO GRANT or DO NOT GRANT permission for my child's image to be used on any of the following church website, social media and printed publications. Then digitally sign below.

Permission

I DO NOT GRANT PERMISSION

I GRANT PERMISSION

Signature (Type or Sign)

Signature field is empty.

Mid-Week Youth

Parents of 3rd grade though 6th grade (as of September 1, 2024). Please register your child below

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Parents of 3rd grade though 6th grade
(as of September 1, 2024).

Please register your child below