Peace Lutheran Ministries
Antigo, WI

School and Childcare Inquiry Form

Thank you for your inquiry about our school and/or childcare. We will contact you within the next business day. Please check out the rest of our website by visiting http://peaceantigo.org/index.php/school-info

School Administrator, David Reineke d.reineke@peaceantigo.org

Childcare Director, Annette Miller a.miller@peaceantigo.org

Office, Melissa Wiebelhaus m.wiebelhaus@peaceantigo.org

Office, Danielle Wiebelhaus d.stroch@peaceantigo.org

Parent / Guardian Information

Title		Title
First Name		First Name
Last Name		Last Name
Address		Address
City		City
State/Region		State/Region
Zip/Postal Code		Zip/Postal Code
Country		Country
Home Phone		Home Phone
Work Phone		Work Phone
Cell Phone		Cell Phone
Email		Email
Relationship		Relationship

Student Information

First Middle Last DOB Current Grade Gender

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