Registration for Children, Youth, & Family Ministries (2022-2023)
Welcome, Families!
We are excited to have you with us at St. Andrew's and we look forward to this year of Being the Light together! In order to better serve our families as we begin to return to formation programming for children and tweens/teens, we invite you to share some information with us about you and your family. If you have any questions about our offerings for Children and Youth, please contact Martha Chaires, Director of Youth, Children, and Family Ministries, at martha@standrewsgso.org.
Parent or Guardian Information
Please provide information about a parent or guardian who will be the primary contact person.
Name (Parent or Guardian)
*
First Name
Last Name
Relationship to Child or Youth
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Family Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add a Second Parent or Guardian (Optional)
Parent or Guardian 2 (Optional)
Please provide information about a second parent or guardian contact. (This is optional.)
Name (Parent or Guardian 2)
First Name
Last Name
Relationship to Child or Youth
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address (if different from that of first Parent or Guardian)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Add First Child or Youth
Child or Youth 1
Please provide information about the first child or youth you are registering.
Name (Child / Youth 1)
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Age Today
*
School Name (Leave blank if not applicable.)
Grade Level for 2022-2023 (Leave blank if not applicable.)
Phone Number (for Youth only, and optional)
Please enter a valid phone number.
Email Address (for Youth only, and optional)
example@example.com
Does the Child or Youth have any ALLERGIES?
No
Yes
If YES, please list ALLERGIES here:
Does the Child or Youth have any MEDICAL CONDITIONS that we should be aware of?
No
Yes
If YES, please list MEDICAL CONDITIONS here:
Does the Child or Youth want to be a volunteer church school teacher's assistant?
No
Yes
Maybe! Please contact me with additional information.
Is there anything you would like us to know about your child or youth?
Add Second Child or Youth
Child or Youth 2
Please provide information about the second child or youth you are registering.
Name (Child / Youth 2)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age Today
School Name (Leave blank if not applicable.)
Grade Level for 2022-2023 (Leave blank if not applicable.)
Phone Number (for Youth only, and optional)
Please enter a valid phone number.
Email Address (for Youth only, and optional)
example@example.com
Does the Child or Youth have any ALLERGIES?
No
Yes
If YES, please list ALLERGIES here:
Does the Child or Youth have any MEDICAL CONDITIONS that we should be aware of?
No
Yes
If YES, please list MEDICAL CONDITIONS here:
Does the Child or Youth want to be a volunteer church school teachers assistant?
No
Yes
Maybe! Please contact me with additional information.
Is there anything you would like us to know about your child or youth?
Add Third Child or Youth
Child or Youth 3
Please provide information about the third child or youth you are registering.
Name (Child / Youth 3)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age Today
School Name (Leave blank if not applicable.)
Grade Level for 2022-2023 (Leave blank if not applicable.)
Phone Number (for Youth only, and optional)
Please enter a valid phone number.
Email Address (for Youth only, and optional)
example@example.com
Does the Child or Youth have any ALLERGIES?
No
Yes
If YES, please list ALLERGIES here:
Does the Child or Youth have any MEDICAL CONDITIONS that we should be aware of?
No
Yes
If YES, please list MEDICAL CONDITIONS here:
Does the Child or Youth want to be a volunteer church school teachers assistant?
No
Yes
Maybe! Please contact me with additional information.
Is there anything you would like us to know about your child or youth?
Add Fourth Child or Youth
Child or Youth 4
Please provide information about the fourth child or youth you are registering.
Name (Child / Youth 4)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age Today
School Name (Leave blank if not applicable.)
Grade Level for 2022-2023 (Leave blank if not applicable.)
Phone Number (for Youth only, and optional)
Please enter a valid phone number.
Email Address (for Youth only, and optional)
example@example.com
Does the Child or Youth have any ALLERGIES?
No
Yes
If YES, please list ALLERGIES here:
Does the Child or Youth have any MEDICAL CONDITIONS that we should be aware of?
No
Yes
If YES, please list MEDICAL CONDITIONS here:
Does the Child or Youth want to be a volunteer church school teachers assistant?
No
Yes
Maybe! Please contact me with additional information.
Is there anything you would like us to know about your child or youth?
Add Fifth Child or Youth
Child or Youth 5
Please provide information about the fifth child or youth you are registering.
Name (Child / Youth 5)
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age Today
School Name (Leave blank if not applicable.)
Grade Level for 2022-2023 (Leave blank if not applicable.)
Phone Number (for Youth only, and optional)
Please enter a valid phone number.
Email Address (for Youth only, and optional)
example@example.com
Does the Child or Youth have any ALLERGIES?
No
Yes
If YES, please list ALLERGIES here:
Does the Child or Youth have any MEDICAL CONDITIONS that we should be aware of?
No
Yes
If YES, please list MEDICAL CONDITIONS here:
Does the Child or Youth want to be a volunteer church school teachers assistant?
No
Yes
Maybe! Please contact me with additional information.
Is there anything you would like us to know about your child or youth?
Complete Form
Photo Release = for all children/youth registered
St. Andrew's Episcopal Church has my permission to use my or my child's photograph publicly to promote their ministry. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee, or other compensation shall become payable to me by reason of such use.
Parent / Guardian Signature
*
Clear
Date Signed
*
-
Month
-
Day
Year
Date
Questions? Notes?
Questions? Notes? (Use this field to let us know here if you have a question about registration or need to add information there wasn't a field for on this form.)
Please use this
Submit
Should be Empty:
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