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Please fill out the following form to register for WOW. Please use a separate form for each child.
(For more information, please contact the St. Andrew Church office)
Participant's Name:
Grade in School:
Birth Date:
Parent(s) / Legal Guardian(s):
Address (Street, City, Zip):
Phone 1 (whose?):
Phone 2 (whose?):
EMail (whose?):
Allergies:
Emergency Contact Info (Name, Phone, Address):
I grant my permission to St. Andrew Lutheran Church of Bristol, CT to use the image of my child in slide shows, video presentations, the church's internet website, television, newspapers, and other publications. No name would appear with the image.
Please list the names and telephone numbers of any persons other than the student's parents that you give permission for us to release your child to:
Name Relationship to Child Phone Number
Please describe any education, health concerns or special considerations that we should be aware of:
I would like more information about...




If other, please specify:
Please type your name as a signature:






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