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FAITH FORMATION REGISTRATION
Student Information
Student Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
School Attending
Grade Entering in the Fall
Baptized Catholic?
*
Yes
No
Sacrament of Reconciliation?
*
Yes
No
First Holy Eucharist?
*
Yes
No
Upload Baptismal certificate
Browse Files
Cancel
of
Parent Information
Mother's Name
*
First Name
Last Name
Mother's Maiden Name
*
Maiden Name
Father's Name
*
First Name
Last Name
Address
*
Street Address
City
State / Province
Zip Code
Primary Contact Number
*
Primary Contact Email
*
example@example.com
Sacrament preparation - Mark the program you are registering your child for
*
Eucharist 1
Eucharist 2 (Holy Eucharist–following the completion of Reconciliation)
Confirmation 1
Confirmation 2 – (following completion of Confirmation 1)
Please select the class time for your child to attend Faith Formation.
*Changes made after the start of the session will occur a $20.00 change fee.
We would like to attend class on:
Tuesday 5-6PM
Thursday 7-8PM
Emergency contact to who the student may be released, other than parent or guardian
Name
Relationship
Phone Number
Address
Name
Relationship
Phone Number
Address
Doctor Name
Phone Number
Insurance
Safe environment / Circle of grace
We hereby give our consent to St Pius V to present the Circle of Grace/ Safe Environment Program to all students each school year. In absence, I opt out of this lesson
*
Yes
No
Parent's Signature
*
Clear
Consent to Photograph
We hereby give permission for the use of our child(ren) photograph, to appear in the St Pius V website and/or digital bulletin boards
*
Yes
No
Parent's Signature
*
Clear
Emergency Authorization
Emergency medical treatment
*
I hereby authorize St Pius V Office of Faith Formation to obtain emergency medical treatment for my child(ren) and understand that this program does not assume responsibility for medical payments.
Parent's Signature
*
Clear
Release of liability
Release of liability
*
I, the parent/guardian of the above named child(ren), hereby give permission for their participation in activities sponsored by St. Pius V. I hereby release and discharge the diocese of Orange, its constituent organizations, employees and volunteers from any and all claims for personal injury or property damage that they may suffer as a result of their participation, or from my failure to provide complete and accurate health insurance information. I hereby e permission to the physician, nurse, dentist or licensed care staff selected by the supervisory personal then present to render medical, dental or other appropriate treatment necessary in case of an emergency
Parent's Signature
*
Clear
Parent Digital Signature
Parent's Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Submit
St. Pius V Catholic Church | 7691 Orangethorpe Ave Buena Park, CA 90621 | (714) 522-2193
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