Parent 1 Name
*
First Name
Last Name
Email Address
*
Parent 2 Name
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
I would like to receive programming reminders by text
Student 1 Name
*
First Name
Last Name
Has student 1 been
Student 1 Birthdate
*
MM
DD
YYYY
Grade in School
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Student 1 Allergies
*
Is there anything about your student that you think we should know?
Medications, Diagnoses, Custody Arrangements, etc...
Student 2 Name
First Name
Last Name
Student 2 has been
Student 2 Birthdate
MM
DD
YYYY
Grade in School
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Student 2 Allergies
Is there anything about your student that you think we should know?
Medications, Diagnoses, Custody Arrangements, etc...
Student 3 Name
First Name
Last Name
Student 3 has been
Student 3 Birthdate
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YYYY
Grade in School
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Student 3 Allergies
Is there anything about your student that you think we should know?
Medications, Diagnoses, Custody Arrangements, etc...
Student 4 Name
First Name
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Student 4 has been
Student 4 Birthdate
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Student 4 Allergies
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.
Is there anything about your student that you think we should know?
Medications, Diagnoses, Custody Arrangements, etc...
