School of Religion Form

Church
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Ministries
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School of Religion Form

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.*
Physician's Phone Number*
Physician's Name*
Insurance Company*
Policy Number*
How many children do you have?*
Student 1 Info
Student 1 Full Name
Student 1 Nickname
Date of Birth
MM slash DD slash YYYY
Gender
Grade Level
Date of Baptism
Church of Baptism
Student 1 Email Address
Allergies
Medications
Student 2 Info
Student 2 Full Name
Student 2 Nickname
Date of Birth
MM slash DD slash YYYY
Gender
Grade Level
Date of Baptism
Church of Baptism
Student 2 Email Address
Allergies
Medications
Student 3 Info
Student 3 Full Name
Student 3 Nickname
Date of Birth
MM slash DD slash YYYY
Gender
Grade Level
Date of Baptism
Church of Baptism
Student 3 Email Address
Allergies
Medications
Student 4 Info
Student 4 Full Name
Student 4 Nickname
Date of Birth
MM slash DD slash YYYY
Gender
Grade Level
Date of Baptism
Church of Baptism
Student 4 Email Address
Allergies
Medications
Parental Consent
I grant permission to use any photos taken of my child for church-related events and promotions.*
Consent*
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.
Date*
MM slash DD slash YYYY
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OUR LADY OF MOUNT CARMEL CATHOLIC CHURCH

11485 Ferdinand Street
P.O. Box 1249
Saint Francisville, LA 70775

(225) 635-3630

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CHAPEL OF OUR LADY OF PERPETUAL HELP

3147 Church Street
Jackson, LA 70748

(225) 635-3630

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Student 1 Info

Student 2 Info

Student 3 Info

Student 4 Info

Parental Consent