3-5th Grade Midweek Registration

Midweek Participant's Name *

First

Middle

Last

Male or Female *

Male
Female

Date of Birth *

MM/DD/YYYY

Grade in school *

3rd
4th
5th

Name of Grade School Attending *

Baptized? *

Yes
No

Parent's Names *

Address *

Please enter your street address, city, state/region, postal/zip code and country.

Phone *

(###) - ### - ####

Parent's Email *

Current Home church *

3rd, 4th and 5th Graders are invited to serve in a worship service as the acolyte (candle lighter). Would your student like to serve as the acolyte? *

No, my child does not want to acolyte.
Yes, please sign my child up for the 8:00 service
Yes, please sign my child up for the 9:30 service
Yes, please sign my child up for the 10:45 service

Photo Release - I give my permission to Good Shepherd Lutheran Church to use photos of my child/children to be used in publications (website, bulletin, newsletter, etc) to promote events and news about Good Shepherd. No personal information such as address or phone number will be advertised or released. *

Yes
No

Does your child/children have any food allergies, medical or behavioral issues that we should know about? If yes, please explain and specify which child. *

Would you be interested in helping as a small group leader? *

Yes, please contact me!
No, I have other responsibilities that don't allow me to volunteer at this time.
I can help as a sub occasionally!

Registration Fee

Payment Method *

Pay Now via PayPal
Pay Later via Check/Cash

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