Pre - Registration Form (one form per

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

Celebration Music DVD ($14.99) QTY ___

Small (6-8) QTY ____

Medium (10-12) QTY ____

Large (14-16) QTY ____