Student Name *

Student Email Address *

Mother's Name *

Mother's Email Address *

Mother's Phone Number *

Father's Name *

Father's Email Address *

Father's Phone Number *

Student Lives With *

Emergency Contact Name *

Emergency Contact Phone Number *

Home Address *

Home Phone Number *

Sex *

Birth Date *

School *

Grade *

Allergies *

Special Needs *

Sacraments NEEDED *

Sacraments RECEIVED *

Is the student's Baptism certificate on file with the church? *

Student's T-shirt Size *

I understand that I, as the parent or legal guardian of the child listed above, am required to read the parent handbook provided by the Religious Education program at St John the Evangelist Catholic Church. I understand and agree to abide by the guidelines, rules, and regulations set forth in this handbook. I understand that my child(ren) need(s) to observe the basic rules of conduct and adhere to the rules stated in the handbook. I understand that failure to comply with the family handbook could bring about disciplinary actions including, in extreme cases, dismissal of my child from the catechetical program. I understand that I am responsible for sharing the rules, regulations and other important information in this handbook with my child. *

I grant permission for the administration of first aid to my child by the people in charge of St. John the Evangelist, and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. In the case of a medical emergency, I understand that every effort will be made to contact the parents/guardian of the participant. In the event, I cannot be reached I hereby give permission to the physician selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia or surgery, if deemed as necessary for my child. *

Please check any and all that apply to your student. *

Parent or Guardian Signature: *

Registration Payment Options *