Godly Play Registration

* Indicates required field

Child's Name *

First

Last

Child's Date of Birth *

Grade in School *

Parents and Guardians Names *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Is email a good way to relay Godly Play informtion to you and your child? *

Yes No

Your Preferred Email *

At West Linn Lutheran Church are you members? *

yes no

Names and ages of child's siblings *

Allergies or Pertinent Medical Info *

Medical Insurance Carrier *

Home Phone Number *

Work Phone Number *

Cell Phone Number *

List of adults besides parents, authorized to pick up child from Godly Play. *

Submit