Zion Lutheran Church

***This electronic form is to be completed for a preliminary headcount.  The hard copy needs to be completed and signed at least 30 days prior to the trip.***

Student's Name:  
Address:  
City:  
Zip:  
Phone Number:   ex. 231-347-3438
Birthdate:   ex. 04/12/2010
Gender:  MaleFemale
Age:  
Email:  
Student's Grade Entering:  6th7th8th9th10th11th12th