Children's Choirs Registration

Name of Student 1:

Student 1 Date of Birth:

Age of Student 1 on 9/1/10:

Grade - Student 1:

Select a Choir:

Name of Student 2:

Student 2 Date of Birth:

Age of Student 2 on 9/1/10:

Grade - Student 2:

Select a Choir Student 2:

Name of Student 3:

Student 3 Date of Birth:

Age of Student 3 on 9/1/10:

Grade - Student 3:

Select a Choir Student 3:

Name of Student 4:

Student 4 Date of Birth:

Age of Student 4 on 9/1/10:

Grade - Student 4:

Select a Choir Student 4:

Parent(s)/Guardian Names:

Address/City/Zip:

Best Contact Ph. Number :

Email:

Do you or your child(ren) play an instrument? What?

Would you or yourchild be willing to share that talent with us in church?

Please note any information that would help us minister to your child(ren). Specify which child. :

Asthma, allergies, medical, learning or other conditions:

Bethlehem Lutheran Church