St. Columba's Episcopal Church Youth Formation Registration 2016
Please use this form to register your young person for 6th Grade, Rite 13, J2A, or YAC.
When you register you will be added to the appropriate youth email list to receive ongoing updates about formation opportunities for youth at St. Cs.
Email address
Young Person's First Name
Your answer
Young Person's Last Name
Your answer
What Grade is your young person entering?
Birthdate
MM
/
DD
/
YYYY
Gender
Young Person's Email
Your answer
Young Person's Mobile Phone
If none leave blank.
Your answer
Parent/Guardian 1 First Name
Your answer
Parent/Guardian 1 Last Name
Your answer
Parent/Guardian 1 Email
Your answer
Parent/Guardian 1 Mobile Phone
Your answer
Parent/Guardian 1 Home Phone
Your answer
Parent/Guardian 2 First Name
Your answer
Parent/Guardian 2 Last Name
Your answer
Parent/Guardian 2 Email
Your answer
Parent/Guardian 2 Mobile Phone
Your answer
Parent/Guardian 2 Home Phone
Your answer
Are you new to St. Columba's?
Home Address Line 1
Your answer
Home Address Line 2
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Photo Consent
I understand that during church activities, there may be photographs taken of me or my child that may be used on the church website or in various St. Columba's publications (printed and online). By checking the "Yes" box below, I give St. Columba's Episcopal Church permission to photograph me/my child and use our pictures solely for the church’s publications, website or Facebook page. It is a policy of St. Columba's never to publish a child’s name on its website, or with any of its online publications. By checking "No," I understand that St. Columba's will to the best of its ability exclude me/my child from any pictures.
May we share contact information with other class parents?
If you choose yes, you agree to publish basic contact information (parent and youth name; parent email and phone; youth email and phone will be excluded) to other members of the class to facilitate coordination and program support. Everyone who selects yes will have access to the contact sheet.
Special notes for leaders?
E.G. allergies; physical, developmental, or behavioral limitations.
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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