2010 IMMANUEL LUTHERAN

SUNDAY SCHOOL REGISTRATION

Classes begin September 12^th at 9:15 a.m.

Ages: 3 years to ancient!

Please Return Registration to ILC’s Main Office

900 Warrior Lane   PO Box 276, Waukee IA 50263       515-987-4089

If you prefer, you may download and print a hardcopy of this form in .PDF format, fill it out, and return it to the church office.

* Required fields are marked with an asterisk.

*Student's Name:

*Street Address:

*City:  *State:  *Zip:   

*Parents' Names:   

*Home Phone: *Cell:

Parent's Work Phone:

*Email:  

*Student's Age:   *Date of Birth:    
**Please note that students must be potty trained; if not poty trained, we will require a parent to stay during the class.

* School Grade Entering this Fall:     

Emergency Contact Information:
If unable to contact parents in an emergency, ILC should contact:

*Name:  *Relationship:

*Phone numbers:

Does your child have any medical condition or allergies requiring special monitoring? Yes    No   If yes, please explain:

In case of emergency and you can't contact me, contact
*Dr.  at (*phone) .

*Hospital preference: .

You have permission to treat my child (printed parent's signature denotes consent):