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Faith Formation Registration 2021-2022

Please complete the form below. Required fields marked with an asterisk *
Are you a registered member of St. Anne?*
Answer Required

Primary Address

State*
Answer Required

Address of Father or Mother if different than primary address

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

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

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
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
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
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

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

Contact Information Child 2

Contact Information Child 3

Contact Information Child 4

Contact Information Child 5

Contact Information Child 6

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Confirmation Email