Registration for Grades 2-12

Registration for the Good Shepard

Fill out the form carefully for registration This registration is for children 3-7
Student Name *

First Name Middle Name Last Name
Birth Date *

Month Day Year
Gender *
Please upload a copy of your child's Birth Certificate. *

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Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Does the child have any medical/physical/learning limitations we should know about? Please explain *
Are there any restriction or court orders in place for child's safety? Please explain, *
Child lives with: *

ONLY MOTHER ONLY FATHER BOTH PARENTS Legal Guardian Other
Parent Name- Father/Guardian *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Parent Name- Mother/Guardian *

First Name Last Name
Phone Number *
Please enter a valid phone number.
Parent/Guardian Email *
example@example.com
Emergency Contact Name, Relationship to child and Phone number *
IMPORTANT INFORMATION

Please answer and sign the following
Media Consent Release I hereby authorize the making of photographs, motion pictures, videotapes, recording, or other memorialization of said event and 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 if to control such making or use. *

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For the protection of children I give permission for my student listed above to participate in the Virtus program: I understand that each lesson will be presented by a catechist to my child during their regular Faith Formation session. I also understand that I can attend the session or visit the Virtus program on line. If my child misses a lesson, it will be my responsibility to pick-up and review the material with him/her. *

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Not a guaranteed spot Please note that this form does not finalize your child's registration and you are not guaranteed acceptance. You will receive a confirmation email or letter with class information. *

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Additional Comments
Should be Empty:

Registration for the Good Shepard

IMPORTANT INFORMATION