Christ the King Lutheran Church 2016-2017 Sunday School Registration

Primary Contact: Typically, the parent of child registering for Sunday School

Parent's First Name *

Parent's Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Cell Phone Number *

May we contact you by text message? *

Home Phone Number

Email Address *

Emergency Contact (Other than primary contact person)

Emergency Contact First Name *

Emergency Contact Last Name *

Cell Phone Number *

Second Phone Number

Additional Contact for Emergencies

Additional Emergency Contact First Name *

Additional Emergency Contact Last Name *

Cell Phone Number *

Second Phone Number

Healthcare Provider and Insurance for Household

If is presumed that the healthcare provider for the parent applies to the child. If not, you can make a note in "Additional Information" on each participant's page.

Medical Insurance Company *

ID# and/or Group# *

Telephone number of Insurance Provider

Physician's Name *

Physician's Telephone Number