The Well Registration

St. Mary High School Ministry

2020/2021 Well Registration Form
Please complete this online registration and medical release form to register your youth for “The Well” catechetical sessions for the 2020-21 school year. The last day for registration is Friday, September 11.

The registration fee is $40 per student. If finances are a concern, please talk to Fr. Eric and register with the paper form as payment is required for the online form.

Unless our district is moved to Phase 3, we are going to continue to meet in person for the Well. If you or your child is uncomfortable with this, please contact me, Jordan. Classes will begin Monday, September 21 with a kickoff Mass at 7:30 P.M. for all students in the church. All the following classes will start at 7:15 P.M.
Last Name *
Father & Mother (Guardians) *
Parent/Guardian Email *
example@example.com
Parent/Guardian Phone Number *
Address *

Street Address

Street Address Line 2

City

Postal / Zip Code
Please add all students *

Medical Emergency Release Form
Add as many children as you're registering *
Medical Insurance Co. *
Policy # *
Doctor *
Doctor Phone Number *
Hospital Preference *
Primary Emergency Contacts: In case of emergency, all attempts will be made to contact one of the persons listed below as soon as possible.
Mother/Guardian 1: *
Phone Number *
Father/Guardian 2: *
*
Name & Relationship: *
Ex: John Doe (Uncle)
*
Name & Relationship: *
Ex: John Doe (Uncle)
Phone Number *
If the Religious Education Staff is unable to reach any of these people, I give my permission for a member of the staff to sign for emergency treatment.
Additional Medical Information: (Allergies or medication)
Please indicate which child the information pertains to. Thank you!
Any special learning problems or needs we should be aware of?
Please indicate which child the information pertains to. Thank you!
Have any questions, comments, or concerns?
Parent/Guardian Signature *

Clear

Registration Fee *

Well Religious Education Fee $40 per student being registered ($1 Convenience Fee)

$ 40.00 Quantity

Total

$ 0.00

St. Mary High School Ministry