Augustana Lutheran Church

Kids’ Kingdom 2022-23

Kids' Kingdom Registration 2021-22

Complete your online Kids' Kingdom registration. Use this form to register up to three children.

Child One

Child First Name

Child Last Name

Birthdate

Age

Current Grade

Street Address

City

State

Zip

Allergies/Medical Concerns

Child Two

Child's First Name

Child Last Name

Birthdate

Age

Current Grade

Is the address for this child different from the above address?

Street Address

City

State

Zip

Allergies/Medical Concerns

Child Three

Child's First Name

Child Last Name

Birthdate

Age

Current Grade

Is the address for this child different from the above address?

Street Address

City

State

Zip

Allergies/Medical Concerns

Parent/Guardian

Parent/Guardain First Name

Parent/Guardian Last Name

Is the address for this child different from the above address?

Street Address

City

State

Zip

Parent/Guadrian Phone

Parent/Guardian Email

Emergency Contact

Emergency Contact Name

Emergency Contact Phone

I give Augustana Lutheran Church to use my child's picture in church publications and social media.

YES

Kids’ Kingdom 2022-23

Child One

Child Two

Child Three

Parent/Guardian

Emergency Contact

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