Fish Lake Immanuel Lutheran Church
Sunday School & Midweek
Registration

Parent/Guardian Name: Emergency Contact (other than home):
Street Address: Name:
City: Phone:
State: Health Insurance Company:
Zip Code: Group / Policy#:
Home Phone:
Cell Phone:
Email:
1. Child Name: 2. Child Name:
Age: Age:
Birth date: Birth date:
Baptismal Birth date: Baptismal Birth date:
Male/Female: Male/Female:
Current Elementary Grade: Current Elementary Grade:
Preschool Age: Preschool Age:
Allergies: Allergies:
Special Needs/Instructions: Special Needs/Instructions:
3. Child Name: 4. Child Name:
Age: Age:
Birth date: Birth date:
Baptismal Birth date: Baptismal Birth date:
Male/Female: Male/Female:
Current Elementary Grade: Current Elementary Grade:
Preschool Age: Preschool Age:
Allergies: Allergies:
Special Needs/Instructions: Special Needs/Instructions:

Comments/Questions (If you would like to volunteer, please note it here):

Waiver:
I authorize the above children to participate in Sunday School and/or Midweek at Fish Lake Immanuel Lutheran Church.
 
I authorize emergency treatment for the above children provided that I cannot be reached.
 
I give permission for the above children to be video/photographed for Fish Lake Church use only.
 
* Strobe lights may be used for decorating and visual effect. Please let us know if your child has a medical condition that could be affected by use of strobe lights.

By pressing the submit button, you accept this waiver and your registration will be processed.