Thanks for your interest in Ministry at Peace Lutheran Church! Please fill out of the following information and we will be in touch with you soon. Child's InformationPlease fill out a form for EACH child you are registering. Which age group are you signing up for? Early Childhood Ministry - Ages 3 to Kindergarten Elementary Youth Ministry - Grades 1 to Gr. 5 Confirmation - Grade 6, 7, 8 Youth Ministry - Grade 6 to 8 Youth Ministry Grade 9 to 12 Please check each specific Ministry program(s) Sunday - Sunday School (Ages 3 - Grade 12, Sun. 9:15-10:15) Tuesday Children's Elem ( Grade 1-3, 3:30-4:45) Release Time (Wed. morning, Gr 2-5) Wednesday Children's Elem (Grade 4 - 5, 3:30-4:45) MAP/2 hr late start - 5 sessions(Gr 1-5) Sunday Night HS Youth Group 6-7:30pm Monday Youth Choir (Gr 6-12) 6-7pm Monday Youth Ensemble (Gr 6-12) 7-8pm Child's Name First Last Child's Birth Date MM slash DD slash YYYY Grade Please enter the grade the child is currently in, or will be entering when school resumes in the fall. Child's Baptism Date MM slash DD slash YYYY Does this child have any allergies or medical concerns? Yes No If yes, please explainParent/Guardian InformationParent/Guardian Name Please enter the parent or guardian's name/s Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Member of Peace? Yes No If no, would you like info on becoming a member? Alternate ContactAlternate Contact Name First Last At times, we need to have an alternate contact to get a hold of. Please fill in that information here. Alternate Contact PhonePlease enter a phone number for the alternate contact.Photographer WaiverPlease enter your initials 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.OtherOther comments:Please use this area to provide information that you think we should know about this child. CAPTCHA* What is 10+22?PhoneThis field is for validation purposes and should be left unchanged.
