Faith Formation Registration

Father's First & Last Name(required)

Father's Address Line 1

Father's Address Line 2

Father's City, State, Zip Code, Country

Father's Home Phone(required)

Father's Cell Phone

Father's Cell Phone Provider

Father's Email

Choose the best way to reach you(required)

Phone Email Text

Mother's First & Last Name(required)

Mother's Address Line 1

Mother's Address Line 2

City, State, Zip, Country

Mother's Home Phone(required)

Mother's Cell Phone

Mother's Cell Phone Provider

Mother's Email

Choose the best way to reach mother:

Phone Email Text

Emergency Contact Person Name

Emergency Contact Person Phone

Child #1 First and Last Name(required)

Child #1 School Level/Grade(required)

Child #1 Birth Date(required)

Child #1 Special Needs/Health Concerns/Allergies

Choose all those that the child has already received:

Baptism First Reconciliation (Confession) First Eucharist (Communion) Confirmation

Child #2 First and Last Name

Child #2 School Level/Grade

Child #2 Birth Date

Child #2 Special Needs/Health Concerns/Allergies

Choose all those Child #2 has already received:

Baptism Reconcilitation (Confession) Eucharist (Communion) Confirmation

Child #3 First & Last Name

Child #3 School Level/Grade

Child #3 Birth Date

Child #3 Special Needs/Health Concerns/Allergies

Choose all those Child #3 has already received:

Baptism Reconciliation (Confession) Eucharist (Communion) Confirmation

Choose any extra programs your child(ren) will participate in:

First Reconciliation & First Communion Prep (Grade 2/Age 7 and up) Confirmation Preparation (Grades 9-12) Youth Fun Nights (Grades 2-8) No Additional Programs

Authorization for Use of Child/Children’s Name(s), Likeness(es), and/or Photographic Image(s) : I grant permission to St. Anthony Catholic Church to use my child’s/children’s name(s), likeness(es), and/or photographic image(s) in the production of parish or or diocesan newsletters, bulletins, websites, posters, bulletin boards, slide shows and other parish or diocesan promotional materials and in articles about the parish that may be published in local or diocesan newspapers. I further understand that St. Anthony Catholic Church is not responsible for access to the Internet information or downloads made by users using the web prior to removal of web references and that my child’s/children’s name(s), likeness or image may continue to be used in any publication already printed or published prior to removal by St. Anthony Catholic Church.

Choose one option(required)

Yes No

Liability Release : I release St. Anthony Catholic Church, its staff and volunteers from all liability in case of accident or injury incurred during St. Anthony Catholic Church’s faith formation and youth ministry programs. If my child/children become(s) injured or ill and I cannot be reached, I authorize for my child/children all surgical, x-ray, laboratory, anesthesia, and/or other medical procedures as may be performed or prescribed by the attending physician and/or emergency personnel. Please note, by typing your name and date below you are providing your electronic signature for this “Liability Release.”

I release St. Anthony Catholic Church, its staff & volunteers from all liability in case of accident or injury incurred during St. Anthony Catholic Church's faith formation and youth ministry programs. Parent Signature (typing your name serves as your signature)(required)

Date (required)