MS Faith Formation 2021-2022

Middle School Faith Formation Registration

Edge by Life Teen | Holy Trinity Catholic Church | 2021-2022 School Year
Register your 6th-8th grade Middle School student for Faith Formation Preparation for the 2021-2022 school year! We are excited to open this year with EDGE by Life Teen! For more information please visit: https://holytrinityladera.org/learn/msff/

To facilitate the registration process, please have card payment at hand for completion.

Student Participant Information
Name *

First Name Last Name
Gender *

Male Female
Birth Date *

Month Day Year
What school does your teen attend? *
Grade *
Faith Formation Information
Has your teen been baptized? *

Yes No
Has your teen had their First Communion? *

Yes No
How many years have you been in Middle School Faith Formation (MSFF)? *
What is the name of the Church of your teen's Baptism? *
Date of Baptism *

Month Day Year
Date
Address of Church Baptized in: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Baptism Certificate *

Cancel of
What church did your teen receive his/her First Communion? *

Parent/Guardian Information
Is your family registered in our parish? *

Yes No
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *
Mother's Name: *

First Name Last Name
Mother's Maiden Name: *
Mother's Cell Phone Number *
Mother's E-mail *
example@example.com
Father's Name: *

First Name Last Name
Father's Cellphone *
Father's E-mail *
example@example.com
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *
Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe. If not, please write N/A. *
Is the participant prescribed an Epi-Pen or Inhaler? If yes, please explain any instructions. If not, please write N/A. *

Permission, Liability, Media & Medical Waivers
I, [the parent (guardian)] of, name of student* hereby give my permission for my or my child's participation in 'Middle School Faith Formation (MSFF)' in the 2021-2022 school year at Holy Trinity Catholic Church. As a condition of my child being allowed to do so, I hereby release and discharge the Diocese of Orange, Holy Trinity Catholic Church, its constituent organizations, including, but not limited to, The Roman Catholic Bishop of Orange, a Corporation Sole, and their officers, employees and volunteers from any and all claims for personal injuries or property damage that s(he) may suffer as a result of my/his/her participation in the activity described above, whether or not such injuries or damages are caused by the negligence, active or passive, of any of the entities or individuals named or described above.

I agree to direct my child to cooperate and follow directions and instructions of parish, or Diocesan personnel responsible for all activities.

I agree, that in the event of injury as a result in my or my child's participation in the above activity, including transportation to and from these activities, whether or not caused by the negligence, active or passive, of the parish, school, or Diocesan youth activities program or any of its agents, employees or volunteers, recourse for the payment of any resulting hospital, medical, dental treatment or related costs and expenses will first be had against any accident, hospital, medical or dental insurance, or any available benefit plan of mine or my spouse. I am not aware of any medical condition which would render it inappropriate for participation in any activity.

I hereby give permission to the physician, nurse, dentist or licensed care staff selected by the supervisory personnel then present to render medical, dental or other appropriate treatment deemed necessary and appropriate by the physician, nurse, dentist or licensed care staff.

I, hereby, authorize the making of photographs, motion pictures, video tapes, or other recordings memorializing said event and my or my child’s participation therein, and the publication and duplication or other use thereof. I, hereby, waive any rights to compensation or any right that I otherwise might have to limit or to control such making or use.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Health Insurance Information
Insurance Carrier *
Policy Number *
Parent Name (Print) *

First Name Last Name
Parent/Guardian Signature *

Clear

Payment Information

Total

$ 0.00

Credit Card

Should be Empty:

Middle School Faith Formation Registration

Faith Formation Information

Permission, Liability, Media & Medical Waivers

Health Insurance Information

Credit Card