Registration - YM - Battenkill Catholic Lifelong Faith

Registration - Youth Ministry, Grades 7-9, St. Patrick's Church

* Indicates required field

Student's Name *

First

Last

Date of Birth *

Date and Place of Baptism *

School *

Grade *

Name of Parent or Guardian #1 *

First

Last

Name of Parent or Guardian #2 *

First

Last

Child's Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent Email *

Student Email *

Home Phone Number *

Student Phone Number *

Parent/Guardian #1 Cell Phone Number *

Parent/Guardian #2 Cell Phone Number *

Emergency Contact *

First

Last

Phone Number *

Please list any allergies or medical needs. *

Please explain any custody issues that we should know about in order to serve your family. *

Please list any special learning needs or anything else we need to know about your child to improve his/her experience in Faith Formation. *

Parent or Guardian would like to volunteer to help with the faith formation program by: *

Bringing snack on special occasions. Helping to prepare materials for an occasional craft project. Serving as a gatekeeper. (Unlock, meet and greet.) Serving as a substitute teacher. Taking photos of program events. Other special skill (Please describe in the Comment box below.

Comment *

Permission to participate in group video calls (Zoom). *

I hereby give my permission for my child to participate in group video calls (Zoom).

Permission for Photographs/Videotapes/Films *

I hereby authorize and give my consent for the taking of pictures (moving or still) of my child and further give my permission for their reproduction for teaching purposes, news release, publication, or community awareness programs.

Is there any other way we can be of assistance to your child or family? *

Date *

Signature *

Submit