FAITH FORMATION REGISTRATION

FAITH FORMATION REGISTRATION

2021-2022
CATHOLIC CHURCH OF THE HOLY SPIRIT
Please read carefully and print clearly. There is room to register up to four children on this form. If you have less than that, ignore the additional registration spaces.
Registration Date

Month Day Year
Date
Email Address
example@example.com
Mailing Address, City, Zip
Father’s Full Name:
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Mother’s Full Name:
Work Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Home Phone #: ( )
EMERGENCY CONTACT (OTHER THAN PARENT) IF NEITHER PARENT CAN BE REACHED:
Name
Best Phone # ( )
First Child’s FIRST MIDDLE & LAST Names *
Grade in School
Age
Date of Birth
Baptized Catholic?

Yes
Baptized In Another Faith?

Yes
Unbaptized

Yes
Received Eucharist?

Yes
Received Eucharist?

No
Received Confirmation?

Yes
Received Confirmation?

No
Second Child's FIRST MIDDLE & LAST Names
Grade in School
Age
Date of Birth
Baptized Catholic?

Yes
Baptized in Another Faith?

Yes
Unbaptized

Yes
Received Eucharist?

Yes
Received Eucharist?

No
Received Confirmation?

Yes
Received Confirmation?

No
Third Child’s FIRST MIDDLE & LAST Names
Grade in School
Age
Date of Birth
Baptized Catholic?

Yes
Baptized in Another Faith?

Yes
Unbaptized?

Yes
Received Eucharist?

Yes
Received Eucharist?

No
Received Confirmation?

Yes
Received Confirmation?

No
Fourth Child’s FIRST MIDDLE & LAST Names
Grade in School
Age
Date of Birth
Baptized Catholic?

Yes
Baptized in Another Faith?

Yes
Unbaptized?

Yes
Received Eucharist?

Yes
Received Eucharist?

No
Received Confirmation?

Yes
Received Confirmation?

No
*Please submit a copy of each child's baptism certificate along with registration.

I am aware that I may request an Opt-Out Form to exclude my child from participating in the Safe Environment / Abuse Prevention
(initial) *
Opt-Out Acknowledgement
IN OUR EFFORTS TO BETTER SERVE THE EDUCATIONAL NEEDS OF YOUR CHILDREN PLEASE PROVIDE THE FOLLOWING INFORMATION:
Does your child(ren) have allergies, learning and/or physical disabilities? If yes, please specify. Child’s Name Allergy/Disabilities
Does your child(ren) have allergies, learning and/or physical disabilities? If yes, please specify. Child’s Name Allergy/Disabilities
Does your child(ren) have allergies, learning and/or physical disabilities? If yes, please specify. Child’s Name Allergy/Disabilities
Does your child(ren) have allergies, learning and/or physical disabilities? If yes, please specify. Child’s Name Allergy/Disabilities
Our family is registered in this parish

: Yes (If not, please request and complete a PRF today.) Please also sign the following documents, in the following pages: 1. Media Release 2. Families Assumption of Risk & Waiver of Liability Relating to Covid-19
Our family attends Mass

Weekly Monthly Seldom Never
Our Child(ren) attended Faith Formation last year:

Weekly Monthly Seldom Never
Our children will attend Faith Formation this year

Weekly Monthly Seldom Never
I would love to share my talent in the following way:

Teach Faith Formation Occasionally sub in class I can help :
Other help
BY LISTING THE NAMES OF THE PEOPLE BELOW YOU ARE ALLOWING OUR FAITH FORMATION TEACHERS TO RELEASE YOUR CHILDREN TO THEM (Minors cannot pick up a child):
NAME / RELATIONSHIP
NAME / RELATIONSHIP
NAME / RELATIONSHIP
NAME / RELATIONSHIP
NAME / RELATIONSHIP
REGISTRATION FEE: One child - $25.00* Each additional child - $20.00*

*Make checks payable to: Catholic Church of the Holy Spirit and maill to 10650 Gulf Beach Highway, Pensacola, FL 32507 or drop off at the office during business hours.

*Pay online through the following link: https://secure.myvanco.com/YJJ8/home

Select Religious Education.

Registration forms are due by August 15, 2020. Please submit this form or download form, and email completed form to Bridget Simpson:

dre@hs.ptdiocese.org

Forms can be dropped off at the office/registration table or place in the offertory. SCHOLARSHIPS AVAILABLE UPON REQUEST.
Media Release Form

Updated August 2020
It is the promise and commitment of the Diocese of Pensacola-Tallahassee to use pictures and videos from Diocesan and/or parish youth events in a dignified and respectful manner. I hereby authorize the Diocese of Pensacola-Tallahassee, including its parishes, schools, and institutions (hereinafter referred to as “Diocese of Pensacola-Tallahassee”) to use, prepare, reproduce, record, video tape, publish, distribute, broadcast, electronically store, and exhibit my name, image, portrait, likeness, words, and/or voice in connection with interviews, sessions, or events conducted, sponsored, or arranged by the Diocese of Pensacola-Tallahassee and its employees, volunteers, and agents. I acknowledge that any notes, photographs, motion pictures, digital images, recordings, or other media format taken of me will become the property of the Diocese of Pensacola-Tallahassee, and I specifically waive any right to compensation for the foregoing. I understand that my likeness, name, image, or voice may be used by the Diocese of Pensacola-Tallahassee without limitation for any professional purpose, now or in the future, and I consent to the same. This permission extends to any authorized print or broadcast media organization that may participate in such preparation, use, reproduction, publication, or distribution.

I release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I also hereby waive any right I may have to inspect and approve in advance the photographs, videos, sound recordings, or publications or media in which I am included. I agree to release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents and designees from any liability by virtue of the use of the photographs or video recordings, regardless of any blurring, distortion, optical illusion, or alteration which may occur when the photographs or videos are taken, printed, or displayed. A photocopy of this release shall be as valid and enforceable as the original.
Child(ren)'s Name(s)
Address
City
State
Zip
Telephone Number
I Accept.
By selecting the "I Accept" box, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions.
Signature
of Adult or Child
Date

Month Day Year
Date
Parent/Guardian Signature
Date

Month Day Year
Date
*The consent and signature of a parent or guardian is required for minors (under the age of 18). I signature is required in either "I Accept" or "I Do Not Accept". Faith Formation registration is not complete with out a signed Media Release.
Revised 8/2020
I DO NOT authorize or release the Diocese of Pensacola-Tallahassee, to use, prepare, reproduce, record, video tape, publish, distribute, broadcast, electronically store, and exhibit my name, image, portrait, likeness, words, and/or voice in connection with interviews, sessions, or events conducted, sponsored, or arranged by the Diocese of Pensacola Tallahassee and its employees, volunteers, and agents.
I Do Not Accept.
By selecting the "I Do Not Accept" box, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Do Not Accept" you consent to be legally bound by this Agreement's terms and conditions.
Signature
Date

Month Day Year
Date
Parent/ Guardian Signature
Date

Month Day Year
Date
*The consent and signature of a parent or guardian is required for minors (under the age of 18).
Revised 8/2020
Pastoral Center | 11 North B Street, Pensacola, FL 32502 | (850) 435-3500 | ww.ptdiocese.org
Assumption of Risk and Waiver of Liability Relating to COVID-19 (Participants)

The novel coronavirus (“COVID-19”) has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. The Catholic Church of the Holy Spirit, Pensacola, FL (Holy Spirit) has put in place preventative measures to reduce the spread of COVID-19; however, we cannot guarantee that you or your child(ren) (specifically named herein below) will not become infected with COVID-19. Furthermore, attending summer camps, activities, programs, functions, or gatherings of any kind sponsored by Holy Spirit could increase your or your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected with COVID-19 by attending summer camps, activities, programs, functions, or gatherings and that such exposure or infection may result in infection, illness, personal injury, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the actions, inactions, omissions, or negligence of myself, my child(ren), and/or others, including, but not limited to, clergy, teachers, employees, staff, coaches, volunteers, and other participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any infection, illness, sickness, damage, loss, expense, and/or liability of any kind (including, but not limited to, personal injury, disability, and death) (hereinafter “Claims”), that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at summer camps, activities, programs, functions, or gatherings of any kind sponsored by Holy Spirit (Pensacola, FL)

On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Holy Spirit (Pensacola, FL) (NAME OF PARISH/SCHOOL), William A. Wack, as Bishop of the Diocese of

Pensacola-Tallahassee, the Diocese of Pensacola-Tallahassee, and all of their current, former, and future representatives, agents, clergy, teachers, employees, staff, coaches, and volunteers (collectively, “the Diocese”) of and from all Claims, including all liabilities, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this assumption of risk, waiver, and release includes any Claims based on the actions, inactions, omissions, or negligence of the Diocese, whether a COVID-19 infection occurs before, during, or after participation in any summer camps, activities, programs, functions, or gatherings of any kind sponsored by Holy Spirit (Pensacola, FL)

This Assumption of Risk and Waiver of Liability Relating to COVID-19 is applicable to my child(ren) stated as follows:
Full names of all family members participating in Faith Formation *
(Date of birth for first child or adult) *

Month Day Year
Date
(Date of birth for second child or adult)

Month Day Year
Date
(Date of birth for third child or adult)

Month Day Year
Date
(Date of birth for fourth child or adult)

Month Day Year
Date
(Date of birth for fifth child or adult)

Month Day Year
Date
Signature of Parent/Guardian *
(Date) *

Month Day Year
Date
(Witness)
(Date)

Month Day Year
Date
(Witness)
(Date)

Month Day Year
Date
Should be Empty:

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FAITH FORMATION REGISTRATION

CATHOLIC CHURCH OF THE HOLY SPIRIT

IN OUR EFFORTS TO BETTER SERVE THE EDUCATIONAL NEEDS OF YOUR CHILDREN PLEASE PROVIDE THE FOLLOWING INFORMATION:

BY LISTING THE NAMES OF THE PEOPLE BELOW YOU ARE ALLOWING OUR FAITH FORMATION TEACHERS TO RELEASE YOUR CHILDREN TO THEM (Minors cannot pick up a child):

Media Release Form

Revised 8/2020

Revised 8/2020