School of Religion Form

Please fill out this form to register your children for our Parish School of Religion.


Father`s Full Name
Father`s Cell Phone
Mother`s Full Name
Mother`s Cell Phone
Home Phone

 

Family Street Address
Mother`s Address if Different
Family Email
Emergency Contact Person
Phone Number
2nd Emergency Contact Person
Phone Number
Father`s Religion
Mother`s Religion
Medical Matters: I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsiblity for the health of my child.
 
Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.  
Medical Release
Physician`s Phone Number
Physician`s Name
Insurance Company Name
Policy Number
Student 1 Full Name
Student 1 Nickname
Date of Birth
Gender
Grade Level
Date of Baptism
Church of Baptism
Church`s Mailing Address
Student 1 Email Address
Allergies
Medications
Student 2 Full Name
Student 2 Nickname
Date of Birth
Grade
Gender
Date of Baptism
Church of Baptism
Church`s Mailing Address
Student 2 Email Address
Allergies
Medications
Student 3 Full Name
Student 3 Nickname
Date of Birth
Grade
Gender
Date of Baptism
Church of Baptism
Church`s Mailing Address
Student 3 Email Address
Allergies
Medications
Student 4 Full Name
Student 4 Nickname
Date of Birth
Grade
Gender
Date of Baptism
Church of Baptism
Church`s Mailing Address
Student 4 Email Address
Allergies
Medications
Comments
I grant permission to use any photos taken of my child for church-related events and promotions.
Photo release
I grant permission for the above child/children to participate in this parish's school of religion program.  Checking this box will serve as my signature.
Parent Signature
Date
To help prevent automated submissions, please enter the letters in the image below.  
     Reload Image
   

Items in RED are required.
 Submit     Reset

 

© Copyright 2017, Mt Carmel Catholic Church. All rights reserved.