Parent/Caregiver 1 last name: *

Parent/Caregiver 1 first name: *

Parent/Caregiver 1 cell phone number: *

Parent/Caregiver 2 last name: *

Parent/Caregiver 2 first name: *

Parent/Caregiver 2 cell phone number: *

Family home address:

City:

Zip Code:

I am on the distribution list to receive regular email updates for families with children and youth:

When we can meet in person again, how can we help? I/we would like to learn more about how to support programs for children and youth-- please send details and information:

Child 1 first name:

Child 1 last name:

Child 1 age:

Child 1 grade:

Child 1 school:

Child 1 birth date:

Is Child 1 baptized?

Please register Child 1 for the following (choose as many as apply for this child):

Allergies and other details to help us best serve Child 1:

Child 2 first name

Child 2 last name

Child 2 age

Child 2 grade

Child 2 school

Child 2 birth date

Is Child 2 baptized?

Please register Child 2 for the following (choose as many as apply for this child):

Allergies and other details to help us best serve Child 2:

Child 3 first name:

Child 3 last name:

Child 3 age:

Child 3 grade:

Child 3 school:

Child 3 birth date:

Is Child 3 baptized?

Please register Child 3 for the following (choose as many as apply for this child):

Allergies and other details to help us best serve Child 3:

Child 4 first name:

Child 4 last name:

Child 4 age:

Child 4 grade:

Child 4 school:

Child 4 birth date:

Is Child 4 baptized?

Please register Child 4 for the following (choose as many as apply for this child):

Allergies and other details to help us best serve Child 4: