St. John's Nursery Care, Sunday School, & Youth Group Registration 2024-2025
Please fill out this form and click submit.
STUDENT 1 NAME
*
Middle Name
Nickname
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Home Phone
Student Mobile Phone
Student (non-school) Email
Birthdate
*
Grade in September 2024
*
Please select one option.
Under 3
PK3
PK4
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
Under 3
PK3
PK4
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Baptized
*
Please select one option.
Yes
No
Select Option
Yes
No
Baptism Date
What musical instrument(s) do they play?
STUDENT 2 NAME
Middle Name
Nickname
Student Mobile Phone
Student (non-school) Email
Birthdate
Grade in September 2024
Please select one option.
Under 3
PK3
PK4
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
Under 3
PK3
PK4
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Baptized
Please select one option.
Yes
No
Select Option
Yes
No
Baptism Date
What musical instrument(s) do they play?
STUDENT 3 NAME
Middle Name
Nickname
Student Mobile Phone
Student (non-school) Email
Birthdate
Grade in September 2024
Please select one option.
Under 3
PK3
PK4
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Select Option
Under 3
PK3
PK4
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Baptized
Please select one option.
Yes
No
Select Option
Yes
No
Baptism Date
What musical instrument(s) do they play?
*
PARENT / GUARDIAN 1 NAME
*
Mobile Phone
*
Email
*
This address will receive a confirmation email
PARENT / GUARDIAN 2 NAME
Mobile Phone
Email
Are there any legal custody restrictions we should be aware of?
*
Please select one option.
Yes
No
Select Option
Yes
No
Please advise us of any relevant conditions, allergies, learning disabilities, EpiPen, Inhaler, or other issues
Photo and Publishing Permission: I agree to allow St. John's Memorial Episcopal to use individual or group photographs of my child(ren) for related news articles, publications, website, social media, and/or advertisements.
*
Please select one option.
Yes
No
Select Option
Yes
No
Submit
Description
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