ࡱ > ? B > ; bjbjupup c: - \ \ $ P * \ , X Z Z Z Z Z Z $ T ~ ~ H t t t F X t X t t t _q @ t D 0 t ^ t t t ~ ~ t \ | : Our Shepherd Lutheran Church Sunday Adventures Registration Form Please fill out one form per family (front and back) and return to the church office. If an additional form is needed, please pick one up from the church office. Date: _______________________________ Student Information: 1. Childs Name:__________________________ ________________________Grade:____ Birthday:________ Baptized: Yes/No Received 1st communion instruction: Yes/No If no, to questions above would you like more information: Yes/No Please list anything that would be helpful for the teachers to know about the student (including allergies, medical conditions, learning disabilities, etc) _________________________________________________________________________________________________________________________________________________________________________________ Please select the dismissal procedure that applies to the above child: ( My child is in 2nd grade or younger and will be signed out by an authorized adult or older sibling listed below. ( My child is in 3rd grade or above and: ( will be signed out by an adult or sibling listed below. ( may be dismissed without an adult/older sibling. 2. Childs Name:__________________________ ________________________Grade:_____ Birthday:________ Baptized: Yes/No Received 1st communion instruction: Yes/No If no, to questions above would you like more information: Yes/No Please list anything that would be helpful for the teachers to know about the student (including allergies, medical conditions, learning disabilities, etc.) __________________________________________________________________________________________________________________________________________________________________________________ Please select the dismissal procedure that applies to the above child: ( My child is in 2nd grade or younger and will be signed out by an authorized adult or older sibling listed below. ( My child is in 3rd grade or above and: ( will be signed out by an adult or sibling listed below. ( may be dismissed without an adult/older sibling. 3. Childs Name:__________________________ _______________________Grade:_____ Birthday:_______ Baptized: Yes/No Received 1st communion instruction: Yes/No If no to questions above would you like more information: Yes/No Please list anything that would be helpful for the teachers to know about the student (including allergies, medical conditions, learning disabilities, etc) ___________________________________________________________________________________________________________________________________________________________________________________ Please select the dismissal procedure that applies to the above child: ( My child is in 2nd grade or younger and will be signed out by an authorized adult or older sibling listed below. ( My child is in 3rd grade or above and: ( will be signed out by an adult or sibling listed below. ( may be dismissed without an adult/older sibling. Parent/ Guardian Information: Parent/Guardian Name (s):__________________________________________________________________________ Address: _________________________________________________________________________________________ Email address:____________________________________________ Phone Number:_________________________ Emergency Contact Name:_______________________________ Relationship to child/ren:______________________ Emergency Contacts number:__________________________________________________ Members of Our Shepherd Lutheran: Yes/No If no, would you like more information about becoming a member: Yes/No The following individuals are authorized to sign out my child (please list all names including parents and older siblings): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ $ / @ A e v # 컰ugVA )hn hl 5>*CJ OJ QJ \^J aJ !hn hn 5>*OJ QJ \^J hK 5>*OJ QJ \^J hK hK 5OJ QJ \^J h$ OJ QJ h6 OJ QJ h4? 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