Formation Registration Form - old - St. Timothy's Episcopal Church Lake Jackson, TX

Christian Formation Registration

* Indicates required field

Child's Name *

First

Last

Birth Date *

Age *

Mailing Address *

City *

Zip *

Mother's Name *

Mother's Email *

Home Phone *

Work *

Cell *

Father's Name *

Father's Email *

Home Phone *

Work *

Cell *

What grade is child in now? *

Name of School *

Is child baptized? *

Has your child participated in Eucharist Instruction? *

Alternative Emergency Contacts

If parents cannot be reached, St. Timothy's is authorized to release a child to the following people:

Name *

Home Phone *

Work/Cell *

Relationship *

Name *

Relationship *

Home Phone *

Work/Cell *

Current Medications *

Alergies to Drugs or Food *

Other Health Information *

Tell us about your child: *

Your email address *

Submit