Prince of Peace Lutheran Church

Please complete sections to the best of your ability, items marked with an * are required; if you have questions, please contact Anna or Brigetta at 739-5255. Please register by Sept. 1st as classes begin September 8th.

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YOUTH SECTION: Please use a separate form for each child you are registering

Student's Name *


First Name	Last Name

Middle Name:

Preferred Nickname (if applicable)

Primary Residence/Address *


Address

Address Line 2

City	State	Zip Code

If alternate address also applies, please share here:

Birth Date *

Baptismal Date (& Church Location if not baptized at Prince of Peace)

Name of Current School Attending for 2020-21 year (List 'Home' if home schooled)

Grade (2020-21) *

Is Child a PoP Member? (Note, membership is not required to participate in FF)

Select one

Yes
No
He/she would be interested in receiving membership information

Please list other siblings also enrolling & grades as applicable

Parent/Guardian Contact Information (can include both parents' first names in "first name" section; or if different last names, list one parent in first box and second parent in second box ) *


First Name	Last Name

Parent/Guardian Phone Number(s) (Please note if cell (C) or home landline (H) by person) *

Parent/Guardian Email Address(es)

Are Parents/Guardians members of Prince of Peace? (Note, membership is not required to participate in FF)

Select one

Yes
No
I/We are interested in receiving membership information

In Case of a Medical Emergency, I give the staff of Prince of Peace Lutheran Church permission to treat my child until a Parent/Guardian can be reached. *

Select one

Yes
No

Additional Emergency Contact if Parent/Guardian unavailable (Name/Phone #/Relation to child)

My child has access to the internet for virtual classtime:

Select from list

I give permission for my child to participate in Zoom classtime for Faith Formation:

Select from list

Please indicate any food allergies or other medical restrictions/conditions we need to be aware of:

Please use this space to list any special educational needs (learning challenges, behavioral concerns etc.) and/or additional information you feel is relevant for PoP Staff to be aware of:

Volunteer Opportunities - I am interested in being a part of the Faith Journey of our children at Prince of Peace.

Select one

Yes
No
Maybe - I would like more information

I would specifically like to help in the areas of(check all that apply)

Select all that apply

Faith Formation Teacher
Helper
Other
None of the above

I am available to volunteer (please check all that apply)

Select all that apply

Please provide names of parents who are interested in volunteering.

PHOTO/VIDEO RELEASE: I grant permission to Prince of Peace Lutheran Church and it's representatives to use my child's likeness/picture in church promotional materials & communications (e.g. newsletter, bulletin boards, website, social media etc.) *

Select one

Yes
No

Signature of a Parent/Guardian (Type in name to confirm registration of the above youth). *

Today's Date *

Prince of Peace Lutheran Church

2020-21 Faith Formation Registration

YOUTH SECTION: Please use a separate form for each child you are registering