Registration Fee: $35/student ($70 max per family)
Please make check payable to Grace Lutheran Church
Student's Full Name:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Birthdate:
Grade:
Baptized:
yes no
Mother's Name:
Father's Name:
Emergency Contact:
Parents are:
Members Attendees Visitors
Email Address:
I give permission to have my student's picture taken to possibly be used on the Grace website:
Yes No
Special needs your student has that leader should be aware of: