EmailMe Form - St John's Church School Registration 2011-2012

Family Information

Mother's Name

First Last

Father's Name

First Last

Mother's Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Father's Address
(If different)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Home Phone

### - ### - ####

Home Phone

### - ### - ####

Cell Phone

### - ### - ####

Cell Phone

### - ### - ####

Mother's Email

Father's Email

If parent's are divorced, who is the custodial parent?

Mother's Church Affiliation

Mother's Baptism Date

MM / DD / YYYY

Church and Location

Mother's
Confirmation/
Reception date

MM / DD / YYYY

Church and Location

Father's Church Affiliation

Father's Baptism Date

MM / DD / YYYY

Church and Location

Father's Confirmation/
Reception date

MM / DD / YYYY

Church and Location

Children Who Will Be Attending St. John’s Church School:

First Child

First Last

M

F

Birthdate

MM / DD / YYYY

Grade

Baptism Date

MM / DD / YYYY

Church and Location

Confirmation Date

MM / DD / YYYY

Church and Location

Special Needs, Medical Concerns, Allergies:

Second Child

First Last

M

F

Birthdate

MM / DD / YYYY

Grade

Baptism Date

MM / DD / YYYY

Church and Location

Confirmation Date

MM / DD / YYYY

Church and Location

Special Needs, Medical Concerns, Allergies:

Third Child

First Last

M

F

Birthdate

MM / DD / YYYY

Grade

Baptism Date

MM / DD / YYYY

Church and Location

Confirmation Date

MM / DD / YYYY

Church and Location

Special Needs, Medical Concerns, Allergies:

Fourth Child

First Last

M

F

Birthdate

MM / DD / YYYY

Grade

Baptism Date

MM / DD / YYYY

Church and Location

Confirmation Date

MM / DD / YYYY

Church and Location

Special Needs, Medical Concerns, Allergies:

Fifth Child

First Last

M

F

Birthdate

MM / DD / YYYY

Grade

Baptism Date

MM / DD / YYYY

Church and Location

Confirmation Date

MM / DD / YYYY

Church and Location

Special Needs, Medical Concerns, Allergies:

Photo/Publicity Release

I give my permission to use my child(ren)’s name, photo, or voice in either media publications, St. John’s website, or in church publications to help promote events and programs at St. John’s Episcopal Church in Ramsey. Should I feel otherwise at any time in the future, I will notify the Church School.

Child's Name

Parrent's/
Guardian's Signature

Date

MM / DD / YYYY