Church of the Redeemer, Bryn Mawr, PA: Children & Youth Registration Form


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Registration Form 2012-13 * Required Errors First Name * Last Name * Parent(s)/Gardian(s) First Name Last Name Address Line 1 * Address Line 2 City * State * ZIP Code * Email Address * Home Phone Number * ( ) - ext. Mother's Cell Number ( ) - ext. Father's Cell Number ( ) - ext. 1. Student's Name First Name * Middle * Last Name * 1. Student's Email Address 1. Student's Number for Texting 1. Student's Birth Date * 1. Student's Age as of 9/1/12 * 1. Student's Grade in School 9/12 * 1. Student's Name of School * 1. Student Baptized? * 1. Student Food Allergies 2. Student's Name First Name Middle Last Name 2. Student's Email Address 2. Student's Number for Texting 2. Student's Birth Date 2. Student's Age as of 9/1/12 2. Student's Grade in School 9/12 2. Student's Name of School 2. Student Baptized? 2. Student's Food Allergies 3. Student's Name First Name Middle Last Name 3. Student's Email Address 3. Student's Number for Texting 3. Student's Birth Date 3. Student's Age as of 9/1/12 3. Student's Grade in School 9/12 3. Student's Name of School 3. Student Baptized? 3. Student's Food Allergies 4. Student's Name First Name Middle Last Name 4. Student's Email Address 4. Student's Number for Texting 4. Student's Birth Date 4. Student's Age as of 9/1/12 4. Student's Grade in School 9/12 4. Student's Name of School 4. Student Baptized? 4. Student's Food Allergies

Church of the Redeemer - 230 Pennswood Road - Bryn Mawr, PA 19010