This is the last name of the family for which you are filling in the form. It is also the last name that you'd like to have in the Church's directory.
Please enter the email addresses of any of the children or dependents in your household to whom you'd like email correspondence from the church sent.
Please enter the address that you'd like to have listed in the Church directory as your home address. Ex: 5090 Johnson Road, Burlington, L9T 6L5
