Easter 4 Kids Registration

The form below includes space to register up to three children in a single family for Easter 4 Kids at Immanuel. If you need to register additional children, please return to the form after you submit it. If you have any questions or issues, please contact us or call us at (920) 684-3404.

Parent / Legal Guardian Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Secondary Phone

(in case of emergency)

(###)

###

####

Email Address

Church Affiliation

List the church name you are a member of, or enter "none" if applicable.

Child 1

USE THIS AREA TO REGISTER YOUR FIRST CHILD FOR Easter 4 Kids.

Child's Name

Grade

Allergy / Health Concerns

Child 2

Use this area to register a second child for Easter 4 Kids.

Child's Name

Grade

Allergy / Health Concerns

Child 3

Use this area to register a third child for Easter 4 Kids.

Child's Name

Grade

Allergy / Health Concerns

Photography Permission

I give permission for the above child(ren) to be photographed at Immanuel’s Easter 4 Kids and have no objections to such photographs being used on Immanuel’s website and social media, in local print media or in promotional fliers. (Children’s names will not be included with photographs posted on Immanuel’s website and social media.)

Yes