Route 66 Registration

  
Parent's First Name*
Parent's Last Name*
Address*
City*
State*
Zip*
Your Home Phone #*
Your E-mail Address
Cell Phone # or other # in case of emergency*
Name of Your Church (leave blank if you do not have a church)
Child's Name*
Child's Gender*
Child's Birthdate*
Child's Name
Child's Gender
Child's Birthdate
Child's Name
Child's Gender
Child's Birthdate
How did you hear about us?
Comments / Include details of any allergies
By completing this registration I hereby consent to the supervised participation of enrolled child(ren) in activitites at Good Shepherd Lutheran Church and School. I waive all liability that Good Shepherd Lutheran Church and School and its staff and volunteers may have for injuries to said child(ren) arising from enrolled activities.


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