Little Flower Youth Faith Formation Registration 2025-20256

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 NameLast Name
Father's Phone Number
Format: (000) 000-0000.
Father's Email
example@example.com
Mother's Name

First NameLast NameMaiden 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.
Family Address

Street Address

Apt. #

CityState

Zip Code
Emergency Contact Name

First NameLast Name
Relationship to Student(s)
Emergency Contact Phone Number
Format: (000) 000-0000.
Child 1 Name

First NameMiddle NameLast Name
Nickname for Nametag
If one is used
Child 1 Gender
Child 1 Grade
Child 1 Birth Date

MonthDayYear
Date
Child Phone Number

Area CodePhone 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?
Child 2 Name

First NameMiddle NameLast Name
Nickname for Nametag
If one is used
Child 2 Gender
Child 2 Birth Date

MonthDayYear
Date
Child 2 Grade
Child Phone Number

Area CodePhone 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?
Child 3 Name

First NameMiddle NameLast Name
Nickname for Nametag
If one is used
Child 3 Gender
Child 3 Birth Date

MonthDayYear
Date
Child 3 Grade
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?
Child 4 Name

First NameLast Name
Child 4 Gender
Child 4 Grade
Child 4 Birth Date

MonthDayYear
Date
Child Phone Number

Area CodePhone 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?
Child 5 Name

First NameLast Name
Child 5 Gender
Child 5 Grade
Child 5 Birth Date

MonthDayYear
Date
Child Phone Number

Area CodePhone 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.?
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.
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.
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
Should be Empty: