Name(s), Last First Gender Last School Year

(please circle) Completed

__________________ ______________ M F PS K 1 2 3 4 5

__________________ ______________ M F PS K 1 2 3 4 5

__________________ ______________ M F PS K 1 2 3 4 5

__________________ ______________ M F PS K 1 2 3 4 5
(Preschool children must be toilet trained.)
Street address:
City: __________________________ State: ______ ZIP: _________________
Home telephone: _________________Cell phone:___________________
Home email address: _____________________________________________
_ In case of emergency, contact: Name _________________ Phone ____________
Allergies or other medical conditions ______________________________________

_____________________________________________________________________
BE SURE TO INVITE YOUR FRIENDS, NEIGHBORS, AND FAMILY!
Please circle the evenings you plan to attend 6:00 p.m. suppers. S M T W Th
Registration forms are available online at stjohns@cableone.net or at the church office.
Celebration Music CD ($6.99) QTY ____ Celebration Music DVD ($14.99) QTY ___
T-shirts ($4.29) are available in child sizes. Small (6-8) QTY ____
Medium (10-12) QTY ____ Large (14-16) QTY ____
PRE-REGISTRATION FORM
(one per family)

St. Johns Lutheran Church
1300 W. Benjamin Ave.
Norfolk, NE 68701