Children's Registration

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Please fill out a separate form for each child.

Child's Last Name *

Child's First Name *

I Would Like My Child To Join:

Nursery

Godly Play

Other - Please let us know what programming you would like to see for your older child in the additional comment section below.

Clear selection

Child's Birthday *

YYYY

What Age/Grade Is the Child Starting this Fall? *

Age 0-6 mos

Age 7mos-12 mos

Age 1-3 yrs

Age 3-6 yrs

Grade K-2

Grade 3-5

Grade 6-8

Grade 9-12

College

Volunteer Only

Does the Child Currently Serve as an Acolyte? *

Yes

Mailing Address (street, city, state and zip) *

Address Listed Above Is *

Emergency Contact Person's Name (First and Last) *

Emergency Contact Number (include area code with dashes) *

Emergency Contact Person's Relationship To Child *

I Would Like To Volunteer In The:

Nursery

Godly Play

Clear selection

Email Address *

Names of Other Children Living at Home with ages (if applicable)

Additional Comments

Submit

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This form was created inside of Immanuel Episcopal Church. Report Abuse