Name *

NOTE: Complete and submit a registration form for each child. Leave fields blank if they don't apply.

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home phone

(###)

###

####

Father's cell

(###)

###

####

Mother's cell

(###)

###

####

Child's Date of Birth *

MM

DD

YYYY

Is your child baptized in the Orthodox Church? *

Yes

No