2023-24 Church of the Ascension:  Youth Faith Formation 
We look forward to working with you and with all children and youth in our parish, sharing and growing together in our faith and in our relationship with the Lord.  Please complete this registration form for our program which goes from September 2023 through May 2024.
อีเมล *
Family Last Name *
Father's First Name *
Mother's Full Name (First Name Last Name) *
Are both parents Catholic? *
Cell Phone Number  555-555-5555 *
I Address Line1 *
Address Line 2
City, State, Zip *
Best way to reach you? *
Emergency Contact (First Name Last Name) *
Emergency Contact Cell Phone (555-555-5555) *
Medical Release and Information:      In case of an accident or serous illness involving my child/ren, I request Church of the Ascension to contact me.  

If they are unable to reach me, I hereby authorize them to call my child's primary physician, indicated below, and follow his/her instructions.  If the physician cannot be reached, church staff may make necessary arrangements (e.g.  call 911).
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จำเป็น
Physician Name (First Name Last Name) *
Physician's Phone Number *
Insurance Provider *
Insurance Policy Number *
Number of children you are registering for 2023-2024 *
Child 1 -- First Name Last Name *
Child 1 - Date of Birth *
Child 1 - Grade *
Child 1's School *
Child 1 - Sacraments Received (Please check all that apply) *
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Does your child have allergies, medications or medical conditions we should be aware of? *
Child 1's allergies, medications or medical conditions that you think we should be aware of *
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