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Family Faith Formation Registration
*
1.
Family Name:
(Required.)
*
2.
Parent One Name
(Required.)
*
3.
Parent One Contact Information
(Required.)
Cell Number
Email Address
Other
4.
Parent Two Name
5.
Parent Two Contact Information
Cell Number
Email Address
Other
*
6.
Mailing Address
(Required.)
*
7.
Child One Information
(Required.)
Name
Date of Birth
Grade in School
School Attending
Baptismal Date
Allergies
Special Concerns
8.
Child Two Information
Name
Date of Birth
Grade in School
School Attending
Baptismal Date
Allergies
Special Concerns
9.
Child Three Information
Name
Date of Birth
Grade in School
School Attending
Baptismal Date
Allergies
Special Concerns
10.
Child Four Information
Name
Date of Birth
Grade in School
School Attending
Baptismal Date
Allergies
Special Concerns
11.
Child Five Information
Name
Date of Birth
Grade in School
School Attending
Baptismal Date
Allergies
Special Concerns
*
12.
EMERGENCY INFORMATION
In the event of an emergency, we will first attempt to reach the child's parent(s). If the parent cannot be reached, we should contact this person at this phone number:
(Required.)
*
13.
I, ___________________________________, give permission for my child(ren) to attend family faith formation and other components of the curriculum and if needed, to be evaluated, diagnosed, treated, and or medicated in accordance with standard medical practices by licensed medical personnel. I relieve the parishes of CCNCC of all responsibilities and consequences that may arise as a result of this treatment. I will not hold CCNCC, its volunteers, or its representatives responsible in the event of injury. Further, I agree to accept any and all financial responsibility as a result of scheduling such treatment. (This answer constitutes as an electronic signature)
(Required.)
*
14.
I hereby authorize and give my consent for the taking of photos, videos of my family members and further give my permission for their reproduction for teaching purposes, news release, publication (print or electronic), or program promotion. Names will only be used with further permission. (This answer constitutes as an electronic signature)
(Required.)
15.
The Diocese requires that we present an age-appropriate class on safe environment for all young people. Please sign if you
do not
wish your child to attend. (This answer constitutes as an electronic signature)
*
16.
I have paid for these services ($60 per family) the following way:
(Required.)
A check written out to CCNCC for $60
Cash (handed to Ann Valley--Faith Formation Director)
Cash (handed to Office Admin)
Venmo/Credit Card
Financial Aid (CCNCCformation@gmail.com)