ST. PAUL'S CHILD/YOUTH REGISTRATION
YOUTH RETREAT, CONFIRMATION, CHILDREN'S CHOIR, CHIMES, WEDNESDAY AT THE WELL, CHILD/YOUTH EDUCATION, YOUTH MISSION TRIP
Email address *
FIRST AND LAST NAME OF CHILD OR YOUTH *
Your answer
MAILING ADDRESS *
Your answer
PHONE NUMBER *
Your answer
BIRTH DATE *
MM
/
DD
/
YYYY
AGE *
GRADE *
T-SHIRT SIZE *
PARENT FIRST AND LAST NAME *
Your answer
EMERGENCY CONTACT (OTHER THAN PARENT) NAME AND PHONE *
Your answer
ALLERGIES *
Your answer
EPI PEN *
OTHER INFORMATION ABOUT CHILD *
Your answer
PLEASE ENROLL IN THE FOLLOWING: *
Required
I GIVE PERMISSION TO TAKE MY CHILD'S PICTURE FOR CLASSROOM PROJECTS AND/OR CHURCH WEBSITES. *
PARENT'S SIGNATURE *
Your answer
DATE *
MM
/
DD
/
YYYY
A copy of your responses will be emailed to the address you provided.
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