Faith Formation Registration

Faith Formation

Formation Registration

Family Name

Address

City, State, Zip Code

Phone Number: (Please indicate if Home [H], Cell [C], or Work [W].

Email:

Father or Male Guardian

Relationship to child

Name

Occupation

Business Phone

Religion

Marital Status

Mother or Female Guardian

Relationship to child

Name

Occupation

Business Phone

Religion

Matrial Status

In case of an emergency, and we are not able to contact you. please indicate the Person (s) to be contacted

Relationship to child

Student #1 Name:

Faith Formation Grade

Date of Birth:

Gender

School

Grade

Student Resides with whom

Any Special Circumstances regarding Custody or whom the child cannot be released to:

Religion

Has student been Baptized in Roman Catholic Church?

Church Name and Address

Has student been baptized in another Christian denomination? If so, please note?

Has student made his/her First Penance?

Has student made his/her First Communion?

Health Issues?

Does your child have any allergies? If yes explain:

Does your child carry an Epi-Pen or medication with them?

Does your child have any special learning needs and does he/she require any special accommodations in school.? Please explain.

Student #2 Name:

Faith Formation Grade

Date of Birth:

Gender

School

Grade

Student Resides with whom

Any Special Circumstances regarding Custody or whom the child cannot be released to:

Religion

Has student been Baptized in Roman Catholic Church?

Church Name and Address

Has student made his/her First Penance?

Has student made his/her First Communion?

Health Issues?

Does your child have any allergies? If yes explain:

Does your child carry an Epi-Pen or medication with them?

Does your child have any special learning needs and does he/she require any special accommodations in school.? Please explain.

In case of an emergency, and we are not able to contact you. please indicate the Person (s) to be contacted. If different from person above First Child.

Relationship to child

In the event of any emergency, I hereby give permission to transport mychild/children to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor

Doctor and Phone number:

Which Parish are you registered with?: You must be registered with St. Timothy or St. Rita Church or permission from your parish to participate in our program.

New Field:

Faith Formation

Formation Registration

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