Good Shepherd Episcopal Church: Parish Publications and Forms: Day School Waiting List Form

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Address:

231 N. Church Street

Rocky Mount, NC 27804

252-442-1134

866-214-8307, toll free fax

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252-442-1134

Stephanie Allen x226

Louise Anderson x230

Sheryll Barnes X221

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Day School:

252-442-1092

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Day School Waiting List Form Please complete form and call 442-1092 to confirm it's reciept. Please complete the first section using the mother's name, address and contact information. * Required Errors First Name * Middle * Last Name * Email Address * Address Line 1 * Address Line 2 City * State * ZIP Code * Home Phone * ( ) - ext. Fax Phone ( ) - ext. Work Phone ( ) - ext. Mobile Phone ( ) - ext. Name of Child * Mother's Employer Father's Name Father's Home Phone Father's Work Phone Father's Cell Phone Father's Employer Father's e-mail address Are you an active parishoner of the Church of the Good Shepherd? Yes No Do you currently have a child in the program? Yes No Have you had a child at Good Shepherd in the past? Yes No Desired Start Date? * Date of Application * Age Group * Child's Birthdate * Waiting List Last Published: August 7, 2008 4:08 PM
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