Club 56 Registration – Augustana Lutheran Church

Student Information

First Name *

Last Name *

Birth Date *

Grade *

Home Address *

City *

State

Zip *

Home Phone

Student's Email

Student's Cell Phone

Parent/Guardian 1

Parent/Guardian Name *

Preferred Phone Number *

Email *

Would you like communications sent to this email?

Yes

No

Parent/Guardian 2

Parent/Guardian Name

Preferred Phone Number

Email

Would you like communications sent to this email?

Yes

No

Additional Student Information

Has student been baptized? *

Baptism Date

Has student had their first communion? *

Where?

Please share any additional information about the student we should know to help make this a successful year.

Be Active in the Augustana Community

Put your faith into action by volunteering in one or more of these areas at Augustana. Your presence and talents are an important part of this community!

Student's photo can be taken and used by Augustana for promotional and social media purposes. *

Yes, photos can be used

No, please don't use photos

Club 56 Registration 2022-2023

Welcome to Club 56 at Augustana!

Student Information

Parent/Guardian 1

Parent/Guardian 2

Additional Student Information

Be Active in the Augustana Community

About Augustana

Quick Links

Contact Us

Worship Hours