Registration

Father's Address *

Line 1

Line 2

City

State

Zip Code

Country

Mother's Address *

Line 1

Line 2

City

State

Zip Code

Country

Father's Home Phone *

Father's Cell *

Father's Cell Phone Service Provider *

Father's Email *

Best way to contact Father *

Phone Email Text

Mother's Home Phone *

Mother's Cell *

Mother's Cell Phone Service Provider *

Mother's Email *

Best way to contact Mother *

Phone Email Text

Child's Special Needs/Health Concerns/Allergies *

Child's Sacraments Received (Check all that apply.) *

Baptism Reconciliation/Confession Eucharist/Communion Confirmation

Child #2 Special Needs/Health Concerns/Allergies *

Child #2 Sacraments Received (Check all that apply.) *

Baptism Reconciliation/Confession Eucharist/Communion Confirmation

Child #3 Special Needs/Health Concerns/Allergies *

Child #3 Sacraments Received (Check all that apply.) *

Baptism Reconciliation/Confession Eucharist/Communion 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.

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."

2019-2020 Faith Formation Program Registration