Children and Youth Ministry Registration 2024-2025

Child's Name

First Name

Last Name

Child's Grade in 2024-2025 School Year

Child's Date of Birth

MM

DD

YYYY

Child's Phone # if Applicable

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Parent/Guardian Email #1

Parent/Guardian phone #1

(###)

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Parent/Guardian Email #2

Parent /Guardian Phone #2

(###)

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Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does your child have any allergies?

Is there anything else we need to know about your child?

Does St. Luke's have permission to use your child's photo on our website, social media and other publicity?

By typing your name in the field below you are signing this form electronically