CTK Cornerstone Kids Registration Form

Please fill out this form and click submit.

Family Information

Parent Name 1

Parent Cell phone 1

Parent Email 1

This address will receive a confirmation email

Parent Name 2

Parent Cell Phone 2

Parent email 2

Address

Anyone else that will bring the student(s)? (grandparents etc.)

Student Information

Child's Name

Date of Birth

Grade in September

Please select one option.

Pre-K (ages 0-4) K 1 2 3 4 5 6 7 8 9 10 11 12

Current Age

Special Info (food allergies, etc.)

Child's Name

Date of Birth

Grade in September

Please select one option.

Pre-k (ages 0-4) K 1 2 3 4 5 6 7 8 9 10 11 12

Current Age

Special Info (food allergies, etc.)

Child's Name

Date of Birth

Grade in September

Please select one option.

Pre-k (ages 0-4) K 1 2 3 4 5 6 7 8 9 10 11 12

Current Age

Special Info (food allergies, etc.)

Child's name

Date of Birth

Grade in September

Please select one option.

Pre-k Age (0-5) K 1 2 3 4 5 6 7 8 9 10 11 12

Current Age

Special info (food allergies, etc.)

Emergency Contact Information

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Photo Release

Christ the King Lutheran Church occasionally has the opportunity to use photos and videos to promote the Sunday School program and other church activities. Uses might include a display board, church newsletter, church website, press releases, etc. Our worship services include a YouTube livestream. No names will be used on the website or in press releases.

I give Christ the King Lutheran Church permission to include my child(ren)

Please select one option.

Yes Yes, with exemption(s)-(describe below) No

Exemptions (photo release) or type n/a

List child(ren)' names

Relationship to child(ren)

Signature

Please select all that apply.

By checking this box, I am indicating that the above information is accurate.

Electronic Signature*

*By entering my name in the box above, I am providing my digital signature on this Form.

Description

Please fill out this form and click submit.

CTK Cornerstone Kids Registration Form

Description

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