Child's Name* First Last Gender*MaleFemaleBirth Date* MM slash DD slash YYYY Grade as of Fall 2014*Kindergarten1st2nd3rd4th5thAge* Parent/Guardian Name* First Last Parent/Guardian Name First Last Preferred Phone*Preferred Email* Address* Street Address City State / Province / Region ZIP / Postal Code Food AllergiesPhotography Release*YesNoConsent for child's photo to be used in occasional St. Martin's Episcopal Church publications. Children's name tags are always blurred.Verify
