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*

YesNo
Baptism Date

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

YesNo
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?

YesNo
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

Yes
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