20 - Faith Formation & Youth Ministry 2020-2021

Hello and welcome to the registration portal for child and teen Faith Formation at Saint Clare of Assisi. Your parish family prayerfully supports you as you lead your child(ren) into a deeper relationship with Jesus Christ and His Church.

The form may take a little time to complete. Thank you for being thorough and patient. The information you are asked to provide is essential to registering everyone in the correct program and, most importantly, to ensure we have adequate information in the case of an emergency.

Have you previously submitted a copy of your child's baptism certificate? If not, you may upload a copy with this form. A photo of the certificate will work fine.

To complete the registration, please have your credit or debit card ready. All information will be kept confidential. Our payment system does not store card numbers.

If your family qualifies for any discounts, they will be applied at the end of the form.

THANK YOU!

1Family and Emergency Information > 2Student Information > 3Family Covenant > 4Payment
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FAMILY INFORMATION

Family Last Name
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
PARENTAL CONTACT INFORMATION
Primary Parental Email for Correspondence

Please enter the email for the primary contact for the family.
Secondary Parental Email
Father's Name Father's Name First Last
Father's Cell Number Father's Cell Number - ### - ### ####
If a custody order is in place, does the Father have custody?

If a custody order is in place, does the Father have custody? Yes No

If a custody order is in place, please send a copy to the parish office.
Mother's Name Mother's Name First Last
Mother's Cell Number Mother's Cell Number - ### - ### ####
If a custody order is in place, does the Mother have custody?

If a custody order is in place, does the Mother have custody? Yes No

If a custody order is in place, please send a copy to the parish office.
EMERGENCY CONTACT, MEDICAL AND HEALTH INFO AND AUTHORIZATION
Emergency Contact Name OTHER than Parents. Emergency Contact Name OTHER than Parents. First Last
Please enter the name, primary phone number and relationship of the emergency contact. This contact will be used for all students in the family.
Emergency Contact Phone OTHER than Parents. Emergency Contact Phone OTHER than Parents. - ### - ### ####
Emergency Contact Relationship to Student
Health and Emergency Agreements
I hereby warrant that to the best of my knowledge, my child(ren) is/are in good health, and I assume all responsibility for the health of my child(ren). I will not send my child(ren) to classes within 24 hours of him/her having fever, vomiting, and/or diarrhea.

I hereby warrant that to the best of my knowledge, my child(ren) is/are in good health, and I assume all responsibility for the health of my child(ren). I will not send my child(ren) to classes within 24 hours of him/her having fever, vomiting, and/or diarrhea. I have read and accept these terms
In the event of an emergency, I hereby give permission to an authorized representative of the parish to call for EMS transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

In the event of an emergency, and if you are unable to reach me at the number I have provided, call our emergency contact listed above.

In the event of an emergency, I hereby give permission to an authorized representative of the parish to call for EMS transportation of my child(ren) to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

In the event of an emergency, and if you are unable to reach me at the number I have provided, call our emergency contact listed above. I have read and accept these terms
Please list all individuals authorized to pick up your child/children. Please include phone numbers.

If parents are the only authorized to pick-up, please enter PARENTS ONLY.
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Revised 6/17/20 - Faith Formation & Youth Ministry 2020-2021

Revised 6/17/20 - Faith Formation & Youth Ministry 2020-2021

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PARENTAL CONTACT INFORMATION

EMERGENCY CONTACT, MEDICAL AND HEALTH INFO AND AUTHORIZATION

Health and Emergency Agreements

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Total

Revised 6/17/20 - Faith Formation & Youth Ministry 2020-2021