Faith Formation Registration

Financial assistance, scholarships, and payment plans are available. Payments can be made to the parish office or on the first day of class.

____ 1 child - $30 ____ 2 children - $50 ____ 3 or more children - $70

Parish name: __________________________________________ Registered Member Y / N

Child’s Name:_________________________

Date of Birth: __________________ Grade: ______ Place of Birth:_________________________

Father’s Name: ________________________________________________________________

Father’s Religion:_____________________ Baptized Y / N Eucharist Y / N Confirmed Y / N

Mother’s Name ( please include maiden name):_______________________________________

Mother’s Religion___________________________ Y / N Eucharist Y / N Confirmed Y / N

Parents Married in the Catholic Church: Y / N Active members: Y / N

Family Address:_________________________________________________________________

_______________________________________________________________________________

Phone Number: _________________________ Email: _____________________________

Emergency Contact Name: __________________________________________________

Phone number:_________________________

Sacramental Records

Date of Baptism:________________________________________________________________

Church of Baptism:______________________________________________________________

City __________________________________ State___________________________________

God Parent Names ___________________________Catholic Y / N Confirmed Y / N Active Y / N

Class Attended Y / N ___________________________________________

Confirmation Date: _______________________________________________________________

Church of Confirmation ____________________________________________________________

Confirmation Name _______________________________________________________________

Confirmation Sponsor _____________________________________________________________

First Communion Date / Place: _____________________________________________________

Any Allergies or Medical Conditions?_________________________________________________________

I, the undersigned, agree with the following statements:

________ I am the parent/guardian of the child indicated above.

________ If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatment for my child.

________ I am giving my permission to take my child's pictures for classroom projects and post them on the church website.

__________________________________________________________________________

Parent Signature and Date