Holiday Service Registration

To have a child's name listed in the program, please submit the information below.

Names received after this date will be listed on a program insert. Names will be accepted through the start of the Service.

Names are NOT held over from year to year. You must submit names every year.


Parents Name(s):
Address:
City/State/ZIP:
Phone:
Cell:
E-mail:
If you are not the child's parent, your name:
Your Phone:
Your Cell:
Your E-mail:

I/We would like to take part in the Holiday Service of Remembrance by:

Title/Author/Instrument:

I/We would like to have the following child / children remembered during the service: