Name:
Address:
City:
State:	-- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:
Gender:	-- Female Male
Telephone:
Cell Phone:
Email:
Date of Birth:	*
Date of Baptism:	*
Date of Confirmation:	*
School:
Grade:
Allergies/Medical Conditions:
	I am interested in joining the St. Nicholas Choir (1st grade and older).
	By checking this box, I give CCCH permission to use unnamed photos of my child(ren) on their website and/or in their publications.
* - if not previously registered

Mother’s Name:
Date of Birth:
Cell Phone:
Work Telephone:
Email:

Father’s Name:
Date of Birth:
Cell Phone:
Work Telephone:
Email: