Children's Ministry Registration Form

Thanks for your interest in the Children's Ministry at Peace Lutheran Church! Please fill out of the following information and we will be in touch with you soon.

Which children's ministry program are you registering for?

Child's Information

Please enter information about the child registering, below.

Please enter the first and last name of the registering child.

Please enter this child's birth date.

Please enter the grade this child will be in school this year, if applicable.

Please enter the date of this child's baptism.

If this child has any allergies, please list them here.

Parent/Guardian Information

Information for the parent of guardian of this child.

Please enter the parent or guardian's name.

Please enter the street address for this parent or guardian.

Please enter the parent or guardian's city of residence.

Please select the parent or guardian's state of residence.

Please enter the parent or guardian's 5 digit zip code.

Please enter the parent or guardian's phone number with area code like ###-###-####.

Please enter the parent or guardian's email address.

Please enter the parent or guardian's preferred method of contact.

Is the parent or guardian a member of Peace Lutheran Church?

Alternate Contact

At times, we need to have an alternate contact to get a hold of. Please fill in that information here.

Please enter a first and last name for this alternate contact.

Please enter a phone number for the alternate contact.

Photography Waiver

By entering your initials in the box below, you hereby grant Peace Lutheran Church leaders permission to photograph/film the minor(s) designated above in any manner or form for any lawful purpose associated with this Peace Lutheran Church program.

Please enter the parent of guardian's initials in this box to signify agreement with the above photo waiver.

Use this area for anything else you think we should know about this child.

This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Enter the characters shown in the image.