Gustavus Adolphus Church
 Growing in Christ   †   Welcoming all people   †  
†   Living out God’s Mission †  

Person filling out registration:

Child 1:

First Name            Middle Initial     

Last Name       

Birth date        

Grade                (or year child will enter kindergarten)

Baptism date   

Child 2:

First Name     Middle Initial     

Last Name       

Birth date        

Grade                (or year child will enter kindergarten)

Baptism date   

Child 3:

First Name     Middle Initial     

Last Name       

Birth date        

Grade                (or year child will enter kindergarten)

Baptism date   

Child 4:

First Name        Middle Initial     

Last Name       

Birth date        

Grade                (or year child will enter kindergarten)

Baptism date   

Family information

Address              

                        Apt., Ste

 City                       State        Zip

Home Phone               
Email 

Mother's Name     

Work Phone                                 Cell/Pager 

Father's Name    

Work Phone                            Cell/Pager 

Emergency Contact Person   

Phone                                 

Medical concerns or special needs- Please talk to Sherrie Nordquist

  Member of GA Church            Prospective Member        Visitor

School District child/children attend