Worship Education Youth Program Member Care Outreach
 
St Luke's Sunday School Registration Form
Family and Emergency Contact Information: (« = required field)

Mother's Name:

  «
Father's Name:
Address:  «
City:  «
Primary Phone:   « xxx-xxx-xxxx
Secondary Phone:  xxx-xxx-xxxx
E-mail:
Are you a member of St. Luke's Church?  Yes       No   «

other church membership (if not St. Lukes)

Child No. 1
First Name:  «
Middle Initial:
Last Name:  «
Birth Date:  « mm/dd/yyyy
Age as of
September 1, 2008:		  «
School Grade entering as of September 1, 2008: (if applicable)
School Attending:
(if applicable)
Is child baptised?  Yes       No   «
Baptism Date: mm/dd/yyyy
Has child received first communion instruction?  Yes       No   «
First Communion Date: mm/dd/yyyy

Any Special Needs/Concerns (Medical or Other)?

> > > >      < < < <

If you are registering more than one child, continue below and return to this button to "Submit" the form when completed.

 

Child No. 2
First Name: «
Middle Initial:
Last Name: «
Birth Date: « mm/dd/yyyy
Age as of
September 1, 2008:		 «
School Grade entering as of September 1, 2008: (if applicable)
School Attending:
(if applicable)
Is child baptised? Yes       No   «
Baptism Date: mm/dd/yyyy
Has child received first communion instruction? Yes       No   «
First Communion Date: mm/dd/yyyy

Any Special Needs/Concerns (Medical or Other)?

^ go to "Submit" button ^

 

Child No. 3
First Name: «
Middle Initial:
Last Name: «
Birth Date: « mm/dd/yyyy
Age as of
September 1, 2008:		 «
School Grade entering as of September 1, 2008: (if applicable)
School Attending:
(if applicable)
Is child baptised? Yes       No   «
Baptism Date: mm/dd/yyyy
Has child received first communion instruction? Yes       No   «
First Communion Date: mm/dd/yyyy

Any Special Needs/Concerns (Medical or Other)?

^ go to "Submit" button ^

 

Child No. 4
First Name: «
Middle Initial:
Last Name: «
Birth Date: « mm/dd/yyyy
Age as of
September 1, 2008:		 «
School Grade entering as of September 1, 2008: (if applicable)
School Attending:
(if applicable)
Is child baptised? Yes       No   «
Baptism Date: mm/dd/yyyy
Has child received first communion instruction? Yes       No   «
First Communion Date: mm/dd/yyyy

Any Special Needs/Concerns (Medical or Other)?

^ go to "Submit" button ^

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      St Luke's Home

205 North Prospect Avenue, Park Ridge, IL  60068    -    847/825-6659    -    fax:847/825-2557    -