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Faith Formation Family Registration

- Faith Formation

Faith Formation Family Registration 2023 - 2024
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- Family/Guardian Last Name REQUIRED Please fill out this field. Please enter valid data.
- Mailing Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Parent #1 contact information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Address (if different than above) Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Email Please enter an email address.
  
  Do you check this email at least once a week? Yes No
  
  Cellular Number Maximum 20 characters Please enter a phone number.
  
  Work Number Maximum 20 characters Please enter a phone number.
  
  Religious Affiliation (if any) Please enter valid data.
- Parent #2 contact information
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Address (if different than above) Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
  
  Email Please enter an email address.
  
  Do you check this email at least once a week? Yes No
  
  Primary Phone Number Maximum 20 characters Please enter a phone number.
  
  Work Number Maximum 20 characters Please enter a phone number.
  
  Religious Affiliation (if any) Please enter valid data.
- Number of students registering REQUIRED Please fill out this field.
  
  Student 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Gender Please enter valid data.
  
  Grade Please enter valid data.
  
  Does your child need to prepare to receive Sacraments REQUIRED Yes. No. Please fill out this field.
  
  Sacraments Needed: Baptism First Reconciliation Confirmation First Communion
  
  Please list any pertinent information, special needs or considerations (allergies, learning disabilities, etc.): Please enter valid data.
  
  Current Tetanus Shot Yes No
  
  List any medications taken: Please enter valid data.
  
  Family physician: REQUIRED Please fill out this field. Please enter valid data.
  
  Family physician phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Insurance Company Name and Policy Number: Please enter valid data.
  
  Emergency contact (other than parent): REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Release:
  
  I have fully read the following medical release and sign voluntarily with knowledge of its terms and conditions: Medical Release
  
  Yes/ I Agree (Medical release) Please select this field.
  
  Publicity Release:
  
  I have fully read the following publicity release and sign voluntarily with knowledge of its terms and conditions: Publicity Release
  
  Publicity Release: Please Mark One REQUIRED No/I Don't Agree Yes/I Agree Please fill out this field.
  
  Student 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Gender Please enter valid data.
  
  Grade Please enter valid data.
  
  Does your child need to prepare to receive Sacraments REQUIRED Yes. No. Please fill out this field.
  
  Sacraments Needed: Baptism First Reconciliation Confirmation First Communion
  
  Please list any pertinent information, special needs or considerations (allergies, learning disabilities, etc.): Please enter valid data.
  
  Current Tetanus Shot Yes No
  
  List any medications taken: Please enter valid data.
  
  Family physician: REQUIRED Please fill out this field. Please enter valid data.
  
  Family physician phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Insurance Company Name and Policy Number: Please enter valid data.
  
  Emergency contact (other than parent): REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Release:
  
  I have fully read the following medical release and sign voluntarily with knowledge of its terms and conditions: Medical Release
  
  Yes/ I Agree (Medical release) Please select this field.
  
  Publicity Release:
  
  I have fully read the following publicity release and sign voluntarily with knowledge of its terms and conditions: Publicity Release
  
  Publicity Release: Please Mark One REQUIRED No/I Don't Agree Yes/I Agree Please fill out this field.
  
  Student 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Gender Please enter valid data.
  
  Grade Please enter valid data.
  
  Does your child need to prepare to receive Sacraments REQUIRED Yes. No. Please fill out this field.
  
  Sacraments Needed: Baptism First Reconciliation Confirmation First Communion
  
  Please list any pertinent information, special needs or considerations (allergies, learning disabilities, etc.): Please enter valid data.
  
  Current Tetanus Shot Yes No
  
  List any medications taken: Please enter valid data.
  
  Family physician: REQUIRED Please fill out this field. Please enter valid data.
  
  Family physician phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Insurance Company Name and Policy Number: Please enter valid data.
  
  Emergency contact (other than parent): REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Release:
  
  I have fully read the following medical release and sign voluntarily with knowledge of its terms and conditions: Medical Release
  
  Yes/ I Agree (Medical release) Please select this field.
  
  Publicity Release:
  
  I have fully read the following publicity release and sign voluntarily with knowledge of its terms and conditions: Publicity Release
  
  Publicity Release: Please Mark One REQUIRED No/I Don't Agree Yes/I Agree Please fill out this field.
  
  Student 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthdate Please enter valid data.
  
  Gender Please enter valid data.
  
  Grade Please enter valid data.
  
  Does your child need to prepare to receive Sacraments REQUIRED Yes. No. Please fill out this field.
  
  Sacraments Needed: Baptism First Reconciliation Confirmation First Communion
  
  Please list any pertinent information, special needs or considerations (allergies, learning disabilities, etc.): Please enter valid data.
  
  Current Tetanus Shot Yes No
  
  List any medications taken: Please enter valid data.
  
  Family physician: REQUIRED Please fill out this field. Please enter valid data.
  
  Family physician phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Insurance Company Name and Policy Number: Please enter valid data.
  
  Emergency contact (other than parent): REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact phone number: REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Medical Release:
  
  I have fully read the following medical release and sign voluntarily with knowledge of its terms and conditions: Medical Release
  
  Yes/ I Agree (Medical release) Please select this field.
  
  Publicity Release:
  
  I have fully read the following publicity release and sign voluntarily with knowledge of its terms and conditions: Publicity Release
  
  Publicity Release: Please Mark One REQUIRED No/I Don't Agree Yes/I Agree Please fill out this field.
- We encourage all children to particpate regardless of a family's ability to pay. If you need financial assistance, please email Cory Dixon.
- Registration Fee Student #1
  45.0 – (PreK thru 6th grade)
  75.0 – (7th thru 12th grade)
- Registration Fee Student #2
  45.0 – (Pre-K thru 6th grade)
  75.0 – (7th thru 12th grade)
- Registration Fee Student #3
  22.5 – (Pre-K thru 6th grade)
  37.5 – (7th thru 12th grade)
- Registration Fee Student #4
  11.25 – (Pre-K thru 6th grade)
  18.75 – (7th thru 12th grade)
Total:

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Faith Formation Family Registration

Medical Release:

Publicity Release:

Medical Release:

Publicity Release:

Medical Release:

Publicity Release:

Medical Release:

Publicity Release:

We encourage all children to particpate regardless of a family's ability to pay. If you need financial assistance, please email Cory Dixon.