Faith Formation Registration 2021-2022

Please complete the form below. Required fields marked with an asterisk *

Family Last Name*

Answer Required

Primary Home Phone*

Answer Required

Are you a registered member of St. Anne?*

Answer Required

Yes

No, then please go to the About section of our website, click on Become a Member, and print the form. Please turn into parish office when completed. and print the form

Primary Address

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Address of Father or Mother if different than primary address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Father/Parental Guardian First and Last Name

Answer Required

Email Address

Answer Required

Religion

Answer Required

Cell Phone*

Number Required

Do you want this number used to receive pertinent text messages?

Answer Required

Yes

Mother/Parental Guardian First and Last Name

Answer Required

Email Address

Answer Required

Religion

Answer Required

Cell Phone

Number Required

Do you want this number used to receive pertinent text messages?

Answer Required

Yes

Please respond to the next set of questions for all children that are being registered. Thank you!

Emergency Contact First and Last Name*

In case of an emergency, illness, or behavior problems, we will contact the parent/legal guardian first. If neither are reachable, please name someone who we can contact in case of emergency, illness, or behavioral issues.

Answer Required

Phone Number*

Number Required

Relationship*

Answer Required

Emergency Hospital*

Answer Required

Emergency Hospital Phone*

Number Required

Family Physician*

Answer Required

Medical Clinic Name*

Answer Required

Medical Clinic Phone*

Number Required

Dentist Name*

Include name and phone number

Answer Required

Dentist Phone*

Number Required

Eye Doctor*

Answer Required

Eye Dr. Phone*

Number Required

I hereby authorize the health care provider or designated person to contact the above listed physician in case of an emergency and parents cannot be reached.*

Answer Required

Yes

List here any necessary: 1) learning & behavior considerations, 2) medical information, and/or 3) special needs*

Please include child's name

Answer Required

I hereby give permission to chaperones of St. Anne Parish to distribute non-prescription/over-the-counter medications and treatments to my child/ward such as, but not limited to: applying bandages, and first-aid ointments, or sprays, ice/heat compresses, dispensing of non-aspirin pain relievers, cough drops, syrups, and antacids and the like.*

Answer Required

Yes

In the event of illness or injury and I am unable to be reached. I do hereby consent to whatever examination, x-ray, anesthetic, medical, surgical, dental diagnosis or treatment and hospital care considered necessary in the best judgement of the attending physician, surgeon, or dentist, and performed by or under the supervision of the medical staff of the hospital or facility furnishing medical or dental services.Question*

Answer Required

Yes

Image & Likeness Release. I give St. Anne’s permission to use any an image of my child in both print and electronic publicity. The videotape, photograph, slide, audiotape, or any other visual or audio reproduction in which my child may appear may include promotional activities such as, but not limited to, websites, social media sites, newsprint, flyers or brochures. St. Anne’s reserves the right to determine which image and likeness is used and how long it will remain on the site or is used in media materials. *

Answer Required

YES, I give permission to St. Anne’s to use my child’s image and likeness for above-said use.

NO, I do not give permission to St. Anne’s to use my child’s image and likeness

Please complete the Contact Information below for each child you are registering for Faith Formation. When done, please scroll down to end for payment options.

Contact Information Child 1

First Name*

Answer Required

Last Name*

Answer Required

Birth Date*

Answer Required

Age & Grade*

Answer Required

Place Baptized (Name, City, State)*

If not baptized, please type n/a

Answer Required

First Eucharist (Name, City, State)*

If sacrament hasn't been made yet, write n/a

Answer Required

First Reconciliation (Name, City, State)*

If sacrament hasn't been made yet, write n/a

Answer Required

Known Allergies*

Type n/a if none

Answer Required

Contact Information Child 2

First Name

Answer Required

Last Name

Answer Required

Birth Date

Answer Required

Age & Grade

Answer Required

Place Baptized (Name, City, State)

If not baptized, please type n/a

Answer Required

First Eucharist (Name, City, State)

If sacrament hasn't been made yet, type n/a

Answer Required

First Reconciliation (Name, City, State)

If sacrament hasn't been made yet, write n/a

Answer Required

Known Allergies

Answer Required

Contact Information Child 3

First Name

Answer Required

Last Name

Answer Required

Birth Date

Answer Required

Age & Grade

Answer Required

Place Baptized (Name, City, State)

If not baptized, please type n/a

Answer Required

Eucharist (Name, City, State)

If sacrament hasn't been made yet, type n/a

Answer Required

Reconciliation (Name, City, State)

If sacrament hasn't been made yet, type n/a

Answer Required

Known Allergies

Answer Required

Contact Information Child 4

First Name

Answer Required

Last Name

Answer Required

Birth Date

Answer Required

Age/Grade

Answer Required

Place Baptized (Name, City, State)

If not baptized, please type n/a

Answer Required

First Eucharist

If sacrament hasn't been made yet, please type n/a

Answer Required

First Reconciliation

If sacrament hasn't been made yet, please type n/a

Answer Required

Known Allergies

Answer Required

Contact Information Child 5

First Name

Answer Required

Last Name

Answer Required

Birth Date

Answer Required

Age & Grade

Answer Required

Place Baptized (Name, City, State)

If not baptized, please type n/a

Answer Required

First Eucharist

If sacrament hasn't been made yet, please type n/a

Answer Required

First Reconciliation

If sacrament hasn't been made yet, please type n/a

Answer Required

Known Allergies

Answer Required

Contact Information Child 6

First Name

Answer Required

Last Name

Answer Required

Birth Date

Answer Required

Age & Grade

Answer Required

Place Baptized (Name, City, State)

If not baptized, type n/a

Answer Required

First Eucharist (Name, City, State)

If sacrament hasn't been yet, type n/a

Answer Required

First Reconciliation (Name, City, State)

If sacrament hasn't been yet, type n/a

Answer Required

Age 3 -10th Grade $50/Student ($150 Family Maximum)

If paying by check, please make it out to St. Anne Faith Formation Program and turn into the parish office.. If you are concerned about paying the fee for Faith Formation, please talk to us! No one will be turned away because of an inability to pay. Only enter a dollar amount below if you plan to pay by credit card.

Answer Required

Please fix the highlighted areas below before submitting.

Faith Formation Registration 2021-2022