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Redeemer 2019-2020 Registration for Children and Youth
The Church of the Redeemer, 5603 North Charles Street, Baltimore, MD 21210
Contact Jan Schroeder: jschroeder@redeemerbaltimore.org, or 410-435-7333, ext. 225
Email address *
Parent/Caregiver 1 last name: *
Your answer
Parent/Caregiver 1 first name: *
Your answer
Parent/Caregiver 1 cell phone number: *
Your answer
Parent/Caregiver 2 last name: *
Your answer
Parent/Caregiver 2 first name: *
Your answer
Parent/Caregiver 2 cell phone number: *
Your answer
Family home address:
Your answer
City:
Your answer
Zip Code:
Your answer
I am on the distribution list to receive regular email updates for families with children and youth:
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:
Your answer
Child 1 last name:
Your answer
Child 1 age:
Your answer
Child 1 grade:
Your answer
Child 1 school:
Your answer
Child 1 birth date:
MM
/
DD
/
YYYY
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:
Your answer
Child 1's primary interests:
Your answer
If you have no additional children to enter, please scroll all the way down and click on "Submit."
Child 2 first name
Your answer
Child 2 last name
Your answer
Child 2 age
Your answer
Child 2 grade
Your answer
Child 2 school
Your answer
Child 2 birth date
MM
/
DD
/
YYYY
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:
Your answer
Child 2's primary interests:
Your answer
If you have no additional children to enter, please scroll all the way down and click on "Submit."
Child 3 first name:
Your answer
Child 3 last name:
Your answer
Child 3 age:
Your answer
Child 3 grade:
Your answer
Child 3 school:
Your answer
Child 3 birth date:
MM
/
DD
/
YYYY
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:
Your answer
Child 3's primary interests:
Your answer
If you have no additional children to enter, please scroll all the way down and click on "Submit."
Child 4 first name:
Your answer
Child 4 last name:
Your answer
Child 4 age:
Your answer
Child 4 grade:
Your answer
Child 4 school:
Your answer
Child 4 birth date:
MM
/
DD
/
YYYY
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:
Your answer
Child 4's primary interests:
Your answer
Submit
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