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Grace Lutheran Church
6000 Broadway
Richmond, IL 60071
Phone 815-678-3082
Fax 815-678-2123
Richmond, IL 60071
Phone 815-678-3082
Fax 815-678-2123
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GRACE LUTHERAN CHURCH 6000 BROADWAY RICHMOND , IL 60071 (815) 678-3082 All Mail to: P. O. Box 425 Richmond, IL. 60071 SUNDAY SCHOOL AND ALPHA REGISTRATION – 2011-2012 Children Pre-K through 5th Grade for Sunday School ALPHA – 6th, 7th and 8th Grade CHILD’S NAME_____________________________________________________ BIRTH DATE________________GRADE IN FALL OF 2011_________________ KNOWN ALLERGIES, MEDICAL CONCERNS, OR LEARNING DISABILITIES______________________________________________________ PHYSICIAN’S NAME_____________________PHONE_____________________ INSURANCE CARRIER________________POLICY/GROUP#_______________ PARENT’S NAME___________________________________________________ ADDRESS__________________________________________ZIP_____________ HOME TELEPHONE_______________ CELL PHONE_____________________ E-MAIL ADDRESS________________________________ PHONE # YOU CAN BE REACHED AT DURING CLASS___________________ EMERGENCY CONTACT________________PHONE #______________________ THOSE PEOPLE AUTHORIZED TO PICK UP CHILDREN:____________________ _____________________________________________________________________ I give my consent for my child to take walking trips in the neighborhood. I understand such trips will be under the supervision of adults, and that precautions will be taken to protect the health and safety of my child. In the event of an emergency where medical treatment is necessary, I give my permission to the church sponsors to seek appropriate medical treatment after every reasonable effort has been made to contact the person identified above. SIGNED_______________________________DATE_________________________ |
| Highlite and print out then Return it to the Grace's Office |
CHANGE OF PLANS! Pastor Andy will be leading an adult education
class between worship services. We will meet in Luther Hall. Sign up
on Rally Day, September 18th. Classes begin September 25th at
9:15.
Contact: Chris Bjorklund, dreamstar_00@msn.com, 815-675-2765
Adult Education
Childrens Classes
Childrens classes will begin October 2nd.