Child's Name *

First Name

Last Name

Parent / Guardian Name *

First Name

Last Name

Phone *

(###)

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Secondary Contact

First Name

Last Name

Secondary Contact Phone

(###)

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Photos and other media *

I give permission for the Parish of St. George to use photographs or video of my child on the website, newsletters, or other parish communications.

I do not give permission for the Parish of St George to use photographs or video of my child in parish communications.