Online Registration is quick and easy. Just follow the steps below and pay using PayPal at the end!

Step 1: Please fill in all blanks and fields.
Select one
  

First Name

 Last Name
Spouse Name (only if applicable)
 Spouse Last Name (only if applicable)
Email Address
Address
City
 State
 Zip Code
Cell Phone # (xxx-xxx-xxxx)
 Home Phone # (xxx-xxx-xxxx)
What's the name of your home church?
  
Emergency Contact's Name
 Emergency Contact's Phone # (xxx-xxx-xxxx)

IMPORTANT! Minor Waiver/Release Required:


All registrants must have a legal guardian read and signoff on Coquina Presbyterian Church's RELEASE OF LIABILITY FOR MINOR PARTICIPANTS. Click below to read this document and then continue with your registration on this page.

RELEASE OF LIABILITY FOR MINOR PARTICIPANTS
(this is a .pdf file and you need Adobe Reader to view it)


Enter Guardian Name or Registrant Name if over 18 years of age.

Digital Signature is hereby given to state that I have read and agree to Coquina's RELEASE OF LIABILITY FOR MINOR PARTICIPANTS as it pertains to my child/ward :

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