Christian Formation Registration

This form will be automatically emailed to St. John's Episcopal Church.

Child's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Grade

Child's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Grade

Child's Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Grade

Parent/Guardian Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Parent/Guardian Email Address

Parent/Guardian Name

First Name

Last Name

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Parent/Guardian Email Address

Emergency Contact

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Special Notes (allergies, special needs, etc.)

Permission

St. John's Episcopal Church | Lafayette may take photographs during this event. We use these photos to record our history and illustrate church life in our newsletter, on our website, and/or on social media. Please indicate whether or not you give permission for photos of your child/ren to be used in this way.

I DO give permission

I do NOT give permission