Epiphany Registration - The Church of the Epiphany

Parish Registration

Please fill out this online form and submit it to get started at Epiphany

Date Joined

Family Last Name *

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

1st Adult

Name - 1st Adult *

Birthdate - 1st Adult *

Religion - 1st Adult *

Email - 1st Adult *

Cell - 1st Adult

Employer - 1st Adult

Position - 1st Adult

2nd Adult

Name - 2nd Adult

Birthdate - 2nd Adult

Religion - 2nd Adult

Email - 2nd Adult

Cell - 2nd Adult

Employer - 2nd Adult

Position - 2nd Adult

Marriage Date

Place

Name of Children in household

Please include last name if different from above

1st Child

First

Last

Birthdate - 1st Child

Baptized? - 1st Child

2nd Child

First

Last

Birthdate - 2nd Child

Baptized? - 2nd Child

3rd Child

First

Last

Birthdate - 3rd Child

Baptized? - 3rd Child

4th Child

First

Last

Birthdate - 4th Child

Baptized? - 4th Child

5th Child

First

Last

Birthdate - 5th Child

Baptized? - 5th Child

Comments

Message

Parish Registration

1st Adult

2nd Adult

Name of Children in household

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