Getta Life
Student's Name*
Date of Birth*
Male/Female*
Male
Female
Parent's Name *
Address*
City*
Home Phone*
Cell Phone *
Email*
School*
Emergency Contact/Phone*
Health Concerns*
Parent Signature*
By checking this box, I am hereby attaching my electronic signature to allow my child to attend GettaLife.
Contact
:
Bev Johnson at 763-441-6429 or via email at
bevmjohnson@hotmail.com
Central Lutheran Church, 1103 School Street, Elk River, MN, USA - (763) 441-2363 OFFICE - (763) 441-0010 FAX -
webmaster@clcelkriver.org
