St. Mary Atlanta Member Registration Form

Please fill out this form and click submit.

Please complete this form to register or update the information of all the members of your household.

Main Church

*

Please select one option.

St. Mary - Atlanta St. Mark- Atlanta St. Paul - Atlanta Other

Person Completing Form Information

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Address

*

Date of Birth

*

Head of Household

*

Please select all that apply.

Yes No

Family Member Information

Please provide the details of the members living in your household.

Spouse Information

Spouse First Name

Spouse Last Name

Spouse Email

Spouse Phone

Spouse Date of Birth

Children Information

Child 1 First Name

Child 1 Last Name

Child 1 Date of Birth

Child 1 Grade

Please select one option.

2-3 Year Old Class 3-4 Year Old Class PreK Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Young Adults

Child 2 First Name

Child 2 Last Name

Child 2 Date of Birth

Child 2 Grade

Please select one option.

2-3 Year Old Class 3-4 Year Old Class PreK Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Young Adults

Child 3 First Name

Child 3 Last Name

Child 3 Date of Birth

Child 3 Grade

Please select one option.

2-3 Year Old Class 3-4 Year Old Class PreK Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Young Adults

Child 4 First Name

Child 4 Last Name

Child 4 Date of Birth

Child 4 Grade

Please select one option.

2-3 Year Old Class 3-4 Year Old Class PreK Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Young Adults

Child 5 First Name

Child 5 Last Name

Child 5 Date of Birth

Child 5 Grade

Please select one option.

2-3 Year Old Class 3-4 Year Old Class PreK Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Young Adults

Additional Members Living in Your Household

Please complete this section if there are persons living in this household that are not immediate family members.

Are there additional members living in this household?

*

Please select one option.

Yes No

Additional Member 1

First Name

Last Name

Email

Phone

Relation To You

Additional Member 2

First Name

Last Name

Email

Phone

Relation To You

Comments

Please add any additional information you would like to.

Description

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