Senior and Junior Counselor Registration
Email address *
Child's Name *
Your answer
Gender *
Rising Grade Level *
Shirt *
Parent or Guardian Name *
Your answer
Full Address *
Your answer
Cell/Primary Number *
Your answer
Secondary Number
Your answer
Allergies or Medical Conditions
Your answer
Emergency Contact Name
Your answer
Emergency Contact Number
Your answer
Emergency Relation to Child
Your answer
Child's Physician
Your answer
Child's Physician Number
Your answer
Photo Release Form
PHOTO RELEASE FORM

By clicking yes on this form, I give St. Timothy’s Episcopal Church the permission to photograph my child and use his or her picture solely for the church’s website, Facebook page, Social Media, or publications released by St. Timothy’s. St. Timothy’s will never publish a child’s name with any of its publications.

Photo Release
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.