First Communion

Students Information

First Name

Last Name

Email Address

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Date of Birth

Gender

Baptism Date

School Grade

Primary Contact

First & Last Name

Relationship to Child

Mobile Number

Secondary Contact

First & Last Name

Relationship To Child

Mobile Number

Permissions

I/we acknowledge that as a participant they could possibly be photographed or captured on video and these photographs or videos may be used on Bethlehem's website or Facebook pages and groups. I/We release Bethlehem Lutheran from any and all liability connected with the use of images of my/ our registered child.

Photo Release

Yes