Student #1 *
Student #1
Submit a separate form for each child.
As of September, 2015
Birthday *
Birthday
Student #2
Student #2
Birthday #2
Birthday #2
Student #3
Student #3
Birthday #3
Birthday #3
Student #4
Student #4
Do another submission for any additional children.
Birthday #4
Birthday #4
Separate with a comma
Address
Address
In the case of multiple addresses, use address of custodial parent or where mailings should go.
Home Phone
Home Phone
Mobile Phone
Mobile Phone
Is it permissible to text?
Preferred Method of Contact
Select all that apply.
Are there any issues regarding your child you would like us to know? (Food allergies, learning styles, attendance availability, anxiety issues, etc.?)
I permit St. Peter's Episcopal Church to print or publish photos or videos of the above-named child on St. Peter's web pages, brochures, bulletin boards, official social media channels in the the church's name, and email communication. No names will be used, only images or video.
Volunteer
Yes! I am interested in being part of the St. Peter's Christian Formation Team! Select all that apply.
Please type your name to confirm registration and authorizations above.