Confirmation Registration 2026-2027

Name

Address

Secondary Address

Parent/Guardian Main Phone

Phone/Guardian Secondary Phone

Parent Email

This address will receive a confirmation email

Can we communicate via text?

Yes No

***If you are a parent who texts, PLEASE give us your cell number as the primary number.

Student Info

Age

Grade

School

Birth Date

Baptismal Date

Mother's Name

Father's Name

In case of emergency, contact

Emergency Contact Phone

Allergies or medical conditions

Special needs or concerns

I grant permission for First Lutheran Church to use photos, videos, or other likeness of the above child for publicity in print or digital form, including the use of social media such as, but not limited to Facebook and Instagram. First Lutheran Church will not include any identifying information about your child.

Yes No

Electronic Signature

Today's Date

Description

Please fill out this form and click submit.

Confirmation Registration 2026-2027

Description

Please Fix the Following