2009 Z.A.P. Registration Form Please fill out a form for each child. Contact the church at 715-698-2707 with additional questions. Thanks!

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Child's Name
Age/Grade Completed
Birthdate
Street Address
City
State
Zip Code
Home Phone Number
Mother's Name
Mother's Work/Cell Phone
Father's Name
Father's Work/Cell Phone
Name of Adult Responsible for Child
Phone Number of Responsible Adult
Address of Responsible Adult
My Child May Walk Home
My Child May Ride Bike Home
My Child May be Picked Up By
Are there any medical concerns we should be aware of (including food allergies)?
Are there any Social/Emotional Concerns?
Additional Comments
May we use your child's name and/or picture on the internet, TV, posters, newspapers, etc?