subject_line
Children's Formation Registration 2014-2015
St. Mary's on-the-Highlands Episcopal Church
1910 12th Ave S
Birmingham, AL 35205
www.stmarysoth.org
www.cgsusa.org
Child Information
First Name
Last Name
Sex
M
F
Birth Date
Grade
3K
4K
5K
1st
2nd
3rd
4th
5th
6th
First Name
Last Name
Sex
M
F
Birth Date
Grade
3K
4K
5K
1st
2nd
3rd
4th
5th
6th
First Name
Last Name
Sex
M
F
Birth Date
Grade
3K
4K
5K
1st
2nd
3rd
4th
5th
6th
First Name
Last Name
Sex
M
F
Birth Date
Grade
3K
4K
5K
1st
2nd
3rd
4th
5th
6th
Member or Visitor?
*
Yes - I am a current church member
No - I am new to the church
Allergies?
*
No
Yes - I have an allergy
Yes - I have an allergy
Art/Photo Waiver-- I hereby grant St. Mary's on-the-Highlands and the National Association of Catechesis of the Good Shepherd the right to use my child's art work/writing and/or my child's photo on their websites and/or publications. I understand that my child's first name, age and location of the atrium may be used to identify my child's photo, writing, and/or art work. I also understand that a limited amount of background information provided by the catechist may be printed in connection with the publication of my child's writing, photo, and/or art work.
*
No-- my child's work/photo may not be considered for use
Yes -- I agree to allow my child's work/photo to be considered for use in publications
Household / Adult Primary Contact
Relationship to Participants:
*
Self
Mother
Father
Guardian
Other
Other
First Name
*
Last Name
*
Address 1
*
Address 2
City
*
State
*
Zip
*
Phone
Alternate Phone
Email Address
*
Powered by
Report abuse