Pre School-5th Grade, Wednesday Education Registration

3 year old (as of 9/1/2023) - 5th Grade

(If you have more than 2 children in this age group you will have to fill out this form again.)

PLEASE REGISTER WHEN YOU KNOW WHICH SESSION WORKS BEST FOR YOUR FAMILY'S FALL SCHEDULE!

Session Choice *

PLEASE REGISTER WHEN YOU KNOW WHICH SESSION WORKS BEST FOR YOUR FAMILY'S FALL SCHEDULE!

Session Choice Session 1: 5:00-5:40 pm Session 2: 5:45-6:25 pm
Child #1 Name Child #1 Name * First Last
Child #1 Gender *

Child #1 Gender Male Female
Child #1 Birthdate Child #1 Birthdate * / MM / DD YYYY
Child #1 Grade (applicable for Fall 2023) *

Child #1 Grade (applicable for Fall 2023) Pre-School 3rd Kindergarten 4th 1st 5th 2nd
Child #1 School (if applicable for Fall 2023) *
Child #2 Name Child #2 Name First Last
Child #2 Gender

Child #2 Gender Male Female
Child #2 Birthdate Child #2 Birthdate / MM / DD YYYY
Child #2 Grade (applicable for Fall 2023)

Child #2 Grade (applicable for Fall 2023) Pre-School 3rd Kindergarten 4th 1st 5th 2nd
Parent (Caregiver) Name #1 Parent (Caregiver) Name #1 * First Last
Parent (Caregiver) Cell Phone #1 Parent (Caregiver) Cell Phone #1 * - ### - ### ####
Parent (Caregiver) Email #1 *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent (Caregiver) Name #2 Parent (Caregiver) Name #2 First Last
Parent (Caregiver) Cell Phone #2 Parent (Caregiver) Cell Phone #2 - ### - ### ####
Parent (Caregiver) Email #2
Parents will be assigned to teach during the school year. (1 MONTH PER CHILD) Please check the month(s) that work best for you: *

Parents will be assigned to teach during the school year. (1 MONTH PER CHILD) Please check the month(s) that work best for you: September October November December January February March
My student(s) would like to be in class with?
Do your children have any special needs or restrictions?
My child has permission to participate in any activity, games, hiking, and field trips planned for the Calvary Lutheran Education Program. I agree that the church, its personnel and volunteers and teachers will not be held responsible and hereby release them from any accidents which may occur.
THIS IS A RELEASE. I HAVE READ AND UNDERSTAND THIS RELEASE. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date Date * / MM / DD YYYY
Multiple Choice

Multiple Choice First option Second option Third option
Spam Protection. Please answer this simple question.
What is the sum of 2 and 4 ?