Little Flower Youth Faith Formation Registration
Edge (Grades 6-7), Purpose (8th grade/Confirmation), and Life Teen (9-12) ---- 2025-2026 School Year. Please have registrations submitted by September 1st, 2025.
Father's Name
First Name
Last Name
Father's Phone Number
Format: (000) 000-0000.
Father's Email
example@example.com
Mother's Name
First Name
Last Name
Maiden Name - Confirmation Only
Mother's Phone Number
Format: (000) 000-0000.
Mother's Email
example@example.com
Primary E-mail- Program notifications will be sent here.
*
Please Select
Father
Mother
Both
Family Address
*
Street Address
Apt. #
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Emergency Contact Name
*
First Name
Last Name
Relationship to Student(s)
*
Emergency Contact Phone Number
*
Format: (000) 000-0000.
Child 1 Name
*
First Name
Middle Name
Last Name
Nickname for Nametag
If one is used
Child 1 Gender
*
Female
Male
Child 1 Grade
*
Please Select
5
6
7
8
9
10
11
12
Child 1 Birth Date
*
-
Month
-
Day
Year
Date
Child Phone Number
-
Area Code
Phone Number
Child Email
example@example.com *for Purpose/Life Teen students only
Does your child have any allergies or medical issues? If so, please describe here with any specific instructions:
*
Add more children?
*
Yes
No
Child 2 Name
First Name
Middle Name
Last Name
Nickname for Nametag
If one is used
Child 2 Gender
Female
Male
Child 2 Birth Date
-
Month
-
Day
Year
Date
Child 2 Grade
Please Select
6
7
8
9
10
11
12
Child Phone Number
-
Area Code
Phone Number
Child Email
example@example.com *for Purpose/Life Teen students only
Does your child have any allergies or medical issues? If so, please describe here with any specific instructions:
Add more children?
Yes
No
Child 3 Name
First Name
Middle Name
Last Name
Nickname for Nametag
If one is used
Child 3 Gender
Female
Male
Child 3 Birth Date
-
Month
-
Day
Year
Date
Child 3 Grade
Please Select
6
7
8
9
10
11
12
Child Phone Number
Format: (000) 000-0000.
Child Email
example@example.com *for Purpose/Life Teen students only
Does your child have any allergies or medical issues? If so, please describe here with any specific instructions:
Add more children?
Yes
No
Child 4 Name
First Name
Last Name
Child 4 Gender
Female
Male
Child 4 Grade
Child 4 Birth Date
-
Month
-
Day
Year
Date
Child Phone Number
-
Area Code
Phone Number
Child Email
example@example.com *for Purpose/Life Teen students only
Does your child have any allergies or medical issues? If so, please describe here with any specific instructions:
Add more children?
Yes
No
Child 5 Name
First Name
Last Name
Child 5 Gender
Female
Male
Child 5 Grade
Child 5 Birth Date
-
Month
-
Day
Year
Date
Child Phone Number
-
Area Code
Phone Number
Child Email
example@example.com *for Purpose/Life Teen students only
Does your child have any allergies or medical issues? If so, please describe here with any specific instructions:
Photo Release: Do you give permission to Little Flower to use pictures of your child(ren) in any future promotional materials, including but not limited to printed material, social media, videos, etc.?
*
Yes
No
I GRANT TO CONSENT FOR MEDICAL CARE. In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by a licensed physician or medical professional; and (2) the transfer of my child to any hospital reasonably accessible. This authorization does not cover major surgery unless opinions of two licensed physicians, concurring in the necessity for surgery, are obtained prior to the performance of such surgery. *Please note that by selecting "Yes" this pertains to all children mentioned in this form. If specifications for certain children are necessary, please denote them below. By selecting "No" this pertains to all children mentioned in this form. If specifications for certain children are necessary, please denote them below.
*
Yes For All Children
No
If you have specific needs for the Consent for Medical Care with your children please specify. (ex. Yes for this child, but no for this child):
*
I GRANT CONSENT TO CONTACT MY CHILD DIRECTLY THROUGH FLOCKNOTE (8th Grade and High School ONLY). Parents will always be copied onto any communications sent out to the children.
Please Select
Yes
No, parent contact only
If you have specific needs for the Consent for Contact with your children please specify. (ex. Yes for this child, but no for this child):
*
Parent Signature
*
Register
Should be Empty: