East Coast Children Conference (ECCC) Servants & Children New England 2024 Registration Form
Please fill in the form below.
New England: 5th & 6th Grade Form
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IMPORTANT:
Servant or Child
*
Servant
Child
Please select servant or child from the drop down menu. Upon your selection the form fields will populate.
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Church Name
*
St. Mark (Natick, MA)
Holy Virgin Mary (Vineyard, Charlton)
St. Mary & St. George (Scuiate, MA)
The Holy Family (Attleboro, MA)
St. Philopater & St. Mina (Wayland, MA)
St. Mary & St. Demiana (Fall River, MA)
St. Shenouda & St. Karas (Milford, MA)
St Mary & St Thomas (Gardner)
St Paul & St John Chrysostom (Boston, MA)
Virgin Mary & Archangel (Hamden, CT)
St. Mary &St. Moses (New London, CT)
The Theotokos & Pope Athanasius, (Cheshire, CT)
St. Mary & Archangel Michael (Nashua, NH)
St. Mary and St. Mena (Rhode Island)
Select your church name
Child Name
*
First Name
Last Name
Parent Name
*
First Name
Last Name
Servant Name
*
First Name
Last Name
Servant Role
*
3rd Grade Servant
4th Grade Servant
5th Grade Servant
6th Grade Servant
OTHER
Service Role
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Parent Cell Number
*
-
Area Code
Phone Number
Servant Cell Number
*
-
Area Code
Phone Number
Child Cell Number
-
Area Code
Phone Number
Parent E-mail
*
Servant E-mail
*
example@example.com
Child Date of Birth
*
-
Month
-
Day
Year
Date
Servant Date of Birth
*
-
Month
-
Day
Year
Date
Grade as of June
*
Grade_5
Grade_6
Child Gender
*
Boy
Girl
Servent Gender
*
Boy
Girl
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