PreRegistration Form

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Pre - Registration Form (one form per

family)

Name(s),

Last

Mail or return to
St. Johns Lutheran Church
1300 W. Benjamin Ave.
Norfolk,
First NE 68701 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 ____
T-shirts ($4.29) are available in child sizes.
Medium (10-12) QTY ____

Celebration Music DVD ($14.99) QTY ___


Small (6-8) QTY ____

Large (14-16) QTY ____

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