Family Faith Registration

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Preferred Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Name of Family Member Completing This Form REQUIRED Please fill out this field. Please enter valid data.

Email (Important!) REQUIRED Please fill out this field. Please enter an email address.

Email is our primary method of communication. If it changes after you register then please let us know.

Emergency Contact REQUIRED Please fill out this field. Please enter valid data.

Emergency Phone Number REQUIRED Please fill out this field. Please enter valid data.

We are always looking for parents to take photos, assist with special events and teach or help in the classroom. If you would like to be contacted to discuss volunteer opportunities, please indicate below.

Yes/No REQUIRED Yes, I would like to be contacted about volunteering No Please fill out this field.

# of Students Enrolling REQUIRED Please fill out this field.
Child 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Child Lives With REQUIRED Both Parents Mother Only Father Only Grandparents Other Please fill out this field.
- Student Grade in September 2023 REQUIRED Please fill out this field.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- Date of Baptism (approximate is acceptable) REQUIRED Please fill out this field. Please enter a date.
- If your child was not baptized at either Sacred Heart or St. Thomas More then you must provide their baptismal certificate by October 15th.
- Special Concerns (if you wish to discuss, please call Maureen Simmons) REQUIRED Allergies Learning Challenges Medications (please list below) Other None Please fill out this field.
- Please list any other information that may impact your child's participation in this program. (If no issues, please enter NONE.)
Child 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Child Lives With REQUIRED Both Parents Mother Only Father Only Grandparents Other Please fill out this field.
- Student Grade in September 2023 REQUIRED Please fill out this field.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- Date of Baptism (approximate is acceptable) REQUIRED Please fill out this field. Please enter a date.
- If your child was not baptized at either Sacred Heart or St. Thomas More then you must provide their baptismal certificate by October 15th.
- Special Concerns (if you wish to discuss, please call Maureen Simmons) REQUIRED Allergies Learning Challenges Medications (please list below) Other None Please fill out this field.
- Please list any other information that may impact your child's participation in this program. (If no issues, please enter NONE.)
Child 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Child Lives With REQUIRED Both Parents Mother Only Father Only Grandparents Other Please fill out this field.
- Student Grade in September 2023 REQUIRED Please fill out this field.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- Date of Baptism (approximate is acceptable) REQUIRED Please fill out this field. Please enter a date.
- If your child was not baptized at either Sacred Heart or St. Thomas More then you must provide their baptismal certificate by October 15th.
- Special Concerns (if you wish to discuss, please call Maureen Simmons) REQUIRED Allergies Learning Challenges Medications (please list below) Other None Please fill out this field.
- Please list any other information that may impact your child's participation in this program. (If no issues, please enter NONE.)
Child 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.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Child Lives With REQUIRED Both Parents Mother Only Father Only Grandparents Other Please fill out this field.
- Student Grade in September 2023 REQUIRED Please fill out this field.
- Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
- Date of Baptism (approximate is acceptable) REQUIRED Please fill out this field. Please enter a date.
- If your child was not baptized at either Sacred Heart or St. Thomas More then you must provide their baptismal certificate by October 15th.
- Special Concerns (if you wish to discuss, please call Maureen Simmons) REQUIRED Allergies Learning Challenges Medications (please list below) Other None Please fill out this field.
- Please list any other information that may impact your child's participation in this program. (If no issues, please enter NONE.)

Photo Permisson: Our Lady Queen of Peace Faith Formation and Parish have opportunities throughout the year when photos of your child(ren) will be taken and published to our social media pages and/or website. Names will not be posted with the photos unless specifically approved for that one specific instance by parent or guardian.

Photo Consent REQUIRED I DO grant permission I do NOT grant permission Please fill out this field.

Medical Release, Consent and Authorization:
In the case of medical emergency, I understand that every effort will be made to contact the above named parent(s) or guardian of the child. In the event of an emergency and I cannot be reached, I hereby give permission for the adult in charge to seek professional medical help and transportation of my child. Permisssion is granted for treatment of minor injury or illness. This permission includes, but is not limited to, the administration of first aid, the use of an ambulance, and the administraiton of anesthesia and/or surgery, under the recommendation of qualified medical personnel should it be impossible to reach any emergency contact.

Parent/Guardian Electronic Signature for Medical Consent REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

I am the legal parent or guardian of the child(ren) and I certify that the information contained on this form is correct.

I Agree Please select this field.

Parent/ Guardian Electronic Signature REQUIRED Please fill out this field. Please enter valid data.

Amount REQUIRED 100.0 – 1 Children 150.0 – 2 Children 150.0 – 3 Children 150.0 – 4 Children Please fill out this field.