Jesus' Lambs

an out-reach program of

Grace Ev. Lutheran Church

Wisconsin Synod

 Office Use Only:  September ______ thru May ______

Registration Fee of $55 received on __________  Check # _________

Registration Form

(please fill out one for each child)
Session Applied for: M, W, F  (4-5 years old)   _____           T & TH (3-4 years old) _____
Child's Name: (first, middle, last)

 
Name Child goes by:  

 
Child's Address: (street, city, state, zip code)

 
Date of Birth:             /            /                                   Sex:      M         F
Father/Guardian: (name, address, contact phone #)

 
Mother/Guardian: (name, address, contact phone #)

 
Marital Status:    Married            Single              Divorced               Separated
Who is authorized to pick up child or should be called in case of emergency? (name/relationship and contact phone #)

 

Who is not authorized (if any) to pick up child:
Brothers/Sisters: (please list names and ages of siblings and whether they live with enrolled child)

 
Has your child had any previous group or preschool experience?

 
Are there any medical problems/allergies of which we should be aware?

 
Are there any special food or eating instructions?

 
Are there any special family situations that we should know about?  (new baby, recent move, etc.)

 
Is your child baptized?     YES      NO           Are you a member of a church, if so which one:

What is your child's concept of God?