Custom Forms | Electoral Roll Application Form

Please complete this form if you would like to be on the Electoral Roll for the Parish and provide the criteria for qualification.
Every six years a new roll is prepared and those on the previous roll are informed so that they can re-apply. If you are not resident in the parish but were on the roll as an habitual worshipper and have been prevented by sickness or absence or other essential reason from worshipping for the past six months you can use Member Declaration D and state the reason.

Contact Information

Name *

First name *

Please enter a First name

Middle name(s)

Surname *

Please enter Surname

Email *

Please enter a valid email

Mobile

Please enter some text

Address *

Address 1 *

Please enter some text

Address 2

Please enter some text

Address 3

Please enter some text

Town *

Please enter some text

County *

Please enter some text

Postcode *

Please enter some text

Country *

Please enter some text

I am a member of the following church *

Please select an option

I agree to the Parish of Stratford-upon-Avon keeping me informed about news, activities and services in the Parish *

By supplying the above email, mobile and address data you consent to our using it, as appropriate, to contact you. You can withdraw this consent at any time by contacting the Parish Office.

Yes

Please select at least one of the options

I agree to the Parish of Stratford-upon-Avon sharing my contact details with the Diocese of Coventry so that they can keep me informed about news, events, activities and services that are occurring in the Diocese *

Yes

Please select at least one of the options

Baptism Declaration

I declare that I am baptised, a lay person and ... *

Those who become 16 in the next 12 months may complete the form and become eligible to be entered on the Roll on their 16th birthday

aged 16 or over

will become 16 on date below

Please select at least one of the options

If you are at present under the age of 16 please indicate the date (which must be within the next 12 months) you will become 16 and will be eligible

Please enter a valid date

Member Declaration - please indicate which applies

A. I am a Member of the Church of England (or of a Church in Communion with the Church of England) and am a resident in the Parish

The only churches at present in communion with the Church of England are other Anglican Churches and certain foreign Churches.

Yes

Please select at least one of the options

B. I am a Member of the Church of England (or a Church in communion with the Church of England) and, not being resident in the parish, I have habitually attended public worship in the parish during the period of six months prior to enrolment.

Yes

Please select at least one of the options

C. I am a Member in good standing of a Church (not in communion with the Church of England) which subscribes to the doctrine of the Holy Trinity and also declare myself to be a member of the Church of England and I have habitually attended public worship in the parish during the period of six months prior to enrolment.

Yes

Please select at least one of the options

D. I am a Member of the Church of England (or of a Church in communion with the Church of England) and, not being resident in the parish, I would have habitually attended public worship during the period of six months prior to enrolment but was prevented from doing so.

Please state reason in box below

Yes

Please select at least one of the options

If you answered 'yes' to D please give the reason

Please enter some text

Signature

I declare that the above answers are true and I apply for inclusion on the Church Electoral Roll of the Parish of Stratford-upon-Avon *

Yes

Please select at least one of the options

Signature *

Please type your name as an electonic signature

Please enter some text

Today's Date *

Please enter a valid date

Electoral Roll Application Form

Contact Information

Baptism Declaration

Member Declaration - please indicate which applies

Signature

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Electoral Roll Application Form

Contact Information

Baptism Declaration

Member Declaration - please indicate which applies

Signature

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