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St. John’s Lutheran Church

An ELCA Congregation in Northfield, Minnesota
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Registration Form

Registration 2019-2020

1 Parent/Guardians
2 Children
3 Medical
4 Children
5 Youth Ministry

  • Instructions

    Please use the following forms to register your child(ren) for the 2018-2019 school year. Visitors/new members are invited to register at any time throughout the year.

    Visit the Children page (Preschool to Grade 5) or Youth page (Grade 6 to 12) pages for more information on the programming.

    We appreciate your timely response in submitting this form. You only need to fill out this form once per family.

  • Parent/Guardian 1

  • Parent/Guardian 2

  • Basic & Contact Information

    Please provide basic information about each of your children.

  • Child 1

  • Child 2

  • Child 3

  • Child 4

  • Child 5

  • Medical & Emergency Information

    Please provide emergency contact information and medical information pertinent to each of your children.

  • Emergency Contact 1 (In the case a parent cannot be reached.)

  • Emergency Contact 2 (In the case a parent or Emergency Contact #1 cannot be reached.)

  • Medical Information

  • Insurance Information

    This is required by hospitals.

  • Parent/Guardian Consent

  • I am the parent or legal guardian of the child(ren) listed on this form, and I am informed of the activities offered by St. John’s Lutheran Church. As parent or legal guardian of my child(ren), I hereby consent for my child(ren) to attend and participate in all activities provided by St. John’s Lutheran Church.

    • I give permission for my child(ren) to participate fully in all activities sponsored by St. John’s Lutheran Church.
    • In case of emergency, I understand that every effort will be made to contact me. If I cannot be reached, I hereby give St. John’s permission to act in my behalf in seeking emergency treatment for my child(ren) in the event that such treatment is deemed necessary. I give permission to those administering emergency treatment to do so, using those measures deemed necessary. I understand that my insurance plan is the primary plan to pay for the dental, medical, or hospital care or treatment that is given to my child(ren).
    • I give my consent to all forms of transportation (personal vehicles, rented vehicles, commercial buses). John’s is not responsible for transportation by non-St. John’s people.
    • I give St. John’s permission to use my child(ren)’s picture for publicity. No personal information will be used.
  • By typing your name here this acts as your signature.

  • It is your responsibility to notify St. John‘s staff of any changes in information. (Policy changes, changes of health conditions, medications, address or phone changes.)

  • Programming for Pre-K Through Grade 5

    Please provide your programming preferences for each of your children age 2 through grade 5.

  • Child 1

  • Use their grade on September 1.
  • Age 2-3; Sunday morning, 9:50 – 10:30 a.m. Once per month.
  • Age 3 – Grade 5; Sunday Morning, 9:45 – 10:30 a.m.

  • Child 2

  • Use their grade on September 1.
  • Age 2-3; Sunday morning, 9:50 – 10:30 a.m. Once per month.
  • Age 3 – Grade 5; Sunday Morning, 9:45 – 10:30 a.m.

  • Child 3

  • Use their grade on September 1.
  • Age 2-3; Sunday morning, 9:50 – 10:30 a.m. Once per month.
  • Age 3 – Grade 5; Sunday Morning, 9:45 – 10:30 a.m.

  • Child 4

  • Use their grade on September 1.
  • Age 2-3; Sunday morning, 9:50 – 10:30 a.m. Once per month.
  • Age 3 – Grade 5; Sunday Morning, 9:45 – 10:30 a.m.

  • Child 5

  • Use their grade on September 1.
  • Age 3 – Grade 5; Sunday Morning, 9:45 – 10:30 a.m.
  • Age 2-3; Sunday morning, 9:50 – 10:30 a.m. Once per month.

  • Programming for Grades 6 Through 12

    Please provide your programming preferences for each of your children in grades 6 through 12.

  • Youth 1

  • Use their grade on September 1.
  • Please check the box next to the item(s) your youth would like to participate in.
  • Please check the box next to the item(s) your youth would like to help with.
  • Please write 3 names of requests for your Confirmation mentor. Adult mentors are members and the same gender.

  • Youth 2

  • Use their grade on September 1.
  • Please check the box next to the item(s) your youth would like to participate in.
  • Please check the box next to the item(s) your youth would like to help with.
  • Please write 3 names of requests for your Confirmation mentor. Adult mentors are members and the same gender.

  • Youth 3

  • Use their grade on September 1.
  • Please check the box next to the item(s) your youth would like to participate in.
  • Please check the box next to the item(s) your youth would like to help with.
  • Please write 3 names of requests for your Confirmation mentor. Adult mentors are members and the same gender.

  • Youth 4

  • Use their grade on September 1.
  • Please check the box next to the item(s) your youth would like to participate in.
  • Please check the box next to the item(s) your youth would like to help with.
  • Please write 3 names of requests for your Confirmation mentor. Adult mentors are members and the same gender.

  • Youth 5

  • Use their grade on September 1.
  • Please check the box next to the item(s) your youth would like to participate in.
  • Please check the box next to the item(s) your youth would like to help with.
  • Please write 3 names of requests for your Confirmation mentor. Adult mentors are members and the same gender.
Outside photo of St. John’s
St. John’s Lutheran Church
500 Third Street West
Northfield, MN 55057
507-645-4429 office@stjohnsnorthfield.org

A Reconciling in Christ Reconciling in Christ logo congregation of the Evangelical Lutheran Church in America (ELCA).

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