Full Name (required)
Preferred Name / Nickname
Candidate's Phone (required)
Street Address (required)
City (required)
State (required)
Zip Code (required)
Candidate's Email (required)
Date of Birth (required)
Place of Birth (required)
Candidate's School (required)
Grade (required) Choose Grade789101112
Preferred Gender Pronoun (required) ChooseMaleFemale
List of Allergies (required)
Guardian 1 (mother, father, stepmother, grandmother, etc)
Guardian 1 Name
Guardian 1 Occupation
Guardian 1 Faith Tradition ChooseEpiscopalOther
Guardian 1 is a member of... ChooseSt. MatthewEpiscopalOther
Guardian 2 (mother, father, stepmother, grandmother, etc)
Guardian 2 Name
Guardian 2 Occupation
Guardian 2 Faith Tradition ChooseEpiscopalOther
Guardian 2 is a member of... ChooseSt. MatthewEpiscopalOther
Student lives with... ChooseBoth parentsMotherFatherGuardian
Emergency Contact: Name
Emergency Contact Relationship
Emergency Contact Phone Number
Godparents
Baptised? (Check box if answer is YES) Yes
Church where Baptised
Date of Baptism
Baptism City
Baptism State
Which liturgies and activities do you participate in? Please check the "YES" box for all that apply. Eucharist 8AM Yes
Eucharist 10AM Yes
Eucharist 5PM Yes
Church School Yes
Youth Group Yes
Diocesan Camp & Retreats Yes
St. Matthew Retreats Yes
Other Activities Yes
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