Shepherd of the Prairie
Children's Music Ministry Registration
Child's Name
Birthdate (mm/dd/yyyy)
Gender
Current Grade
Parent(s) Names
Home Phone
 

Note: required fields are shown in color

Address
City
Zip
Parent(s)  E-mail
Mother Cell Phone
 
Other  E-mail
Father  Cell Phone

 
Able to read music?
Instruments able to play
Choir(s) interested
in joining:









Food Allergies
Other Concerns


We need your help! Please mark any of the following that you would be willing to volunteer for: