Children's Membership Form

Children's Membership Form

Online membership registration form for parents/guardians to register children as members of St. Stephen's Episcopal Church, Coconut Grove.
Child's Full Name

First NameMiddle NameLast Name
Preferred First Name
Gender
Preferred Pronouns
Date of Birth

MonthDayYear
Date
Place of Birth (City and State)
Name of School
Current Grade
Graduation Year
Parent/Guardian Information
Name of Parent/Guardian #1
Primary Phone Number of Parent/Guardian #1
Please enter a valid phone number.Format: (000) 000-0000.
Name of Parent/Guardian #2
Primary Phone Number of Parent/Guardian #2
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian #1 Email
example@example.com
Parent/Guardian #2 Email
example@example.com
Child's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Baptism and Confirmation Status
Child is Baptized
Baptism Date

MonthDayYear
Date
Name, denomination, and location of church (city and state) of where the child was baptized
Child is Confirmed
Confirmation Date

MonthDayYear
Date
Name, denomination, and location of church (city and state) of where the child was confirmed
If confirmed in a denomination other than the Episcopal Church, has the child been Received into the Episcopal Church, on another church in the Anglican Communion?
Reception Date

MonthDayYear
Date
Reception - Name and location of church (city and state)
Membership Transfer and Authorization
Child is a member of another Episcopal church, please transfer their membership to St. Stephen's Episcopal Church, Coconut Grove
Transfer Church Name, Denomination, and Location (City and State)
Parent/Guardian Signature
Date

MonthDayYear
Date
Should be Empty:

Children's Membership Form

Parent/Guardian Information

Baptism and Confirmation Status

Membership Transfer and Authorization