Name of Student:

Student Age:

Student Birth Date:

Student Grade:

Name of the school student attends:

Allergies:

Parent's Name:

Address:

Phone:

Email:

Parent's Name:

Address:

Phone:

Email:

In case of emergency, notify:

Phone:

Relationship:

Email:

Parents:

I would be willing to help with:
StorytellerClassroom TeacherYouth Group (5th - High School)

I would like information:
BaptismConfirmationCommunion Preparation ClassAcoloytesYouth Group

Events we would like to help with:
Barbara C Harris Camp Church School Family RetreatAdvent Wreath MakingGingerbread House Making & SupperChristmas PageantEpiphany Trope

Picture use permission: I give The Church of the Holy Spirit permission to take and include photos/videos of my child for promotional use, including but not limited to the church website, and informational brochures.

I give permission for my child to receive Holy Communion:
YesNo

Parent Signature (type name below):