Little Flower Youth Faith Formation Registration 2021-2022

Little Flower Youth Faith Formation Registration

Catechesis of the Good Shepherd (K-5) and Purpose (6,7 & 8) ---- 2021-2022 School Year
Father's Name

First Name Last Name
Father's Phone Number

Area Code Phone Number
Father's Email
example@example.com
Mother's Name

First Name Last Name
Mother's Phone Number

Area Code Phone Number
Mother's Email
example@example.com
Family Address *

Street Address

Apt. #

City State / Province

Postal / Zip Code
Emergency Contact Name *

First Name Last Name
Relationship to Student(s) *
Emergency Contact Phone Number *

Area Code Phone Number
Child 1 Name *

First Name Last Name
Child 1 Gender *

Female Male
Child 1 Grade *
Child 1 Birth Date *

Month Day Year
Date
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 Name Last Name
Child 2 Gender *

Female Male
Child 2 Grade *
Child 2 Birth Date *

Month Day Year
Date
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 Name Last Name
Child 3 Gender *

Female Male
Child 3 Grade *
Child 3 Birth Date *

Month Day Year
Date
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 Name Last Name
Child 4 Gender *

Female Male
Child 4 Grade *
Child 4 Birth Date *

Month Day Year
Date
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 Name Last Name
Child 5 Gender *

Female Male
Child 5 Grade *
Child 5 Birth Date *

Month Day Year
Date
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. Be 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)
Parent Signature *

Clear
Should be Empty:

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