2021-2022 FLC Children's Ministry Registration
Welcome to Children's and Family Ministry at First Lutheran Church, Cedar Rapids, IA! Thank you for completing this form in preparation for the 2021-2022 program year. It helps us to know who to expect and that we have the most accurate information for your family. Please fill out ONE form per household.
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Household Last Name *
Household Address *
Phone #1 *
Phone #2
Email Address *
Parent/Guardian Name/s *
Child 1 Name *
Child 1 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.) *
Child 1 Birthdate *
MM
/
DD
/
YYYY
Child 1: Medical/Allergy or Other Important Information for this child
Child 2 Name
Child 2 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.)
Child 2 Birthdate
MM
/
DD
/
YYYY
Child 2: Medical/Allergy or Other Important Information for this child
Child 3 Name
Child 3 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.)
Child 3 Birthdate
MM
/
DD
/
YYYY
Child 3: Medical/Allergy or Other Important Information for this child
Child 4 Name
Child 4 Grade (entering Fall 2021 (ie. Preschool 3s, 1st Grade, etc.)
Child 4 Birthdate
MM
/
DD
/
YYYY
Child 4: Medical/Allergy or Other Important Information for this child
Who can pick up this child/these children from their classroom?
First Lutheran Church Member? (You don't have to be!) *
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