Our Lady of Lourdes New Family Form
Please fill out your family information below. Your contact and family information is private and will be kept confidential. We can't wait to see your family this upcoming weekend!
Email address *
First Name *
Your answer
Last Name *
Your answer
Phone Number *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
Province/State *
Your answer
Postal Code *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Parent Mobile Number *
Your answer
Child #1 Full Name *
Your answer
Child #1 Birthdate *
MM
/
DD
/
YYYY
Child #1 Allergies / Medical Information
Your answer
Child #2 Full Name
Your answer
Child #2 Birthdate
MM
/
DD
/
YYYY
Child #2 Allergies/Medical Information
Your answer
Child #3 Full Name
Your answer
Child #3 Birthdate
MM
/
DD
/
YYYY
Child #3 Allergies/Medical Information
Your answer
Child #4 Full Name
Your answer
Child #4 Birthdate
MM
/
DD
/
YYYY
Child #4 Allergies/Medical Information
Your answer
Anything else you want us to know?
Your answer
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