2019-2020 St. Denis & St. Patrick Faith Formation Registration
Please submit a separate form for each child
Student Last Name *
Your answer
Student First Name *
Your answer
Student Middle Name *
Your answer
Student Gender
Student Birthdate *
MM
/
DD
/
YYYY
Student Grade *
Name to send correspondence to *
Your answer
Relationship to Student *
Your answer
Email Address *
Your answer
Best Number to Reach (Please indicate if cell or home or work) *
Your answer
Additional Contact Number
Your answer
Mailing Address *
Your answer
Additional Contact Person (in case of emergency) - Person's Name *
Your answer
Additional Contact Person (in case of emergency) - Person's Relationship to Student *
Your answer
Additional Contact Person (in case of emergency) - Person's Phone Number *
Your answer
Medical Information - List allergies (medications, food, plants, insects, etc.)
Your answer
Medical Information - Does student have any physical limitations?
Your answer
Medical Information - Are there any other special medical conditions that we should be aware of? (Please include any learning disabilities, cognitive disorders)
Your answer
Picture Consent - Occasionally, we post pictures on our website and other parish locations (bulletins, display boards, slideshows, newsletters, etc.) to inform others about program. Do we have your permission to include your child's picture in any of these media sources? *
Program Volunteers - Please check areas you are interested in learning more about.
Tuition/Fees - please write check to St. Denis OR St. Patrick *
Required
This is my first time attending Religious Education classes at St. Denis. *
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