Parent 1 Name *

First Name

Last Name

Parent 2 Name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Student 1 Name *

First Name

Last Name

Has student 1 been

Baptized

First Communion

Confirmed

Student 1 Birthdate *

MM

DD

YYYY

Student 2 Name

First Name

Last Name

Student 2 has been

Baptized

First Communion

Confirmed

Student 2 Birthdate

MM

DD

YYYY

Student 3 Name

First Name

Last Name

Student 3 has been

Baptized

First Communion

Confirmed

Student 3 Birthdate

MM

DD

YYYY

Student 4 Name

First Name

Last Name

Student 4 has been

Baptized

First Communion

Confirmed

Student 4 Birthdate

MM

DD

YYYY

Media Release *

I give permission for my child to be photographed, and/or video/audio taped at King of kings Lutheran Church or at events sponsored and/or approved by King of kings. I understand that these photos or video/audio tapes may be used for instructional purposes, such as staff training, conference presentations, and/or general use by the children, and staff throughout the church. These photos may also be displayed on bulletin boards at King of kings Lutheran Church, on the King of kings’ web page or in flyers or brochures promoting the church and/or children’s programs.

I agree