Mass Schedule: Saturday 4 p.m. | Sunday 10:30 a.m.
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Faith Formation & Youth Ministry Registration
Program fee is $30 per child with a maximum of $100 per family. Fee will be waived for those with financial need; please contact Laura Hollinrake, DRE, at (641) 828-7050 Ext. 2.
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Indicates required field
Father's Name
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First
Last
Mother's Name
*
First
Last
Father's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mother's Address
*
Line 1
Line 2
City
State
Zip Code
Country
If father and mother live at the same address, you may type "same" in fields for Mother's Address."
Father's Primary Phone Number
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Father's Alternate Phone Number
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Father's Email
*
Mother's Primary Phone Number
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Mother's Alternate Phone Number
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Mother's Email
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Primary Contact Person:
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Father
Mother
Both
Other
If Primary Contact is "Other", please provide name, address, and phone number.
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Other Primary Contact's Phone Number
*
Other's Primary Contact's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Child's Name
*
First
Last
Child's Grade
*
Child's Birth Date
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Child's Special Needs/Health Concerns/Allergies
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Child's Sacraments Received (Check all that apply.)
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Baptism
Reconciliation/Confession
Eucharist/Communion
Confirmation
Child #2 Name
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First
Last
Child #2 Grade
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Child #2 Birth Date
*
Child #2 Special Needs/Health Concerns/Allergies
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Child #2 Sacraments Received (Check all that apply.)
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Baptism
Reconciliation
Eucharist
Confirmation
Child #3 Name
*
First
Last
Child #3 Grade
*
Child #3 Birth Date
*
Child #3 Special Needs/Health Concerns/Allergies
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Child #3 Sacraments Received (Check all that apply.)
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Baptism
Reconciliation
Eucharist
Confirmation
Authorization for Use of Child/Children's Name(s), Likeness(es), and/or Photographic Image(s)
*
Yes
No
I grant permission to St. Anthony Catholic Church to use my child's/children's name(s), likeness(es), and/or photographic image(s) in the production of parish or or diocesan newsletters, bulletins, websites, posters, bulletin boards, slide shows and other parish or diocesan promotional materials and in articles about the parish that may be published in local or diocesan newspapers. I further understand that St. Anthony Catholic Church is not responsible for access to the Internet information or downloads made by users using the web prior to removal of web references and that my child’s/children's name(s), likeness or image may continue to be used in any publication already printed or published prior to removal by St. Anthony Catholic Church.
Liability Release
*
I release St. Anthony Catholic Church, its staff and volunteers from all liability in case of accident or injury incurred during St. Anthony Catholic Church’s faith formation and youth ministry programs. If my child/children become(s) injured or ill and I cannot be reached, I authorize for my child/children all surgical, x-ray, laboratory, anesthesia, and/or other medical procedures as may be performed or prescribed by the attending physician and/or emergency personnel.
Please note, by typing your name and date below you are providing your electronic signature for this "Liability Release."
Parent Signature
*
By typing your name in this line you are providing your electronic signature for the "Liability Release."
Date
*
Submit
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