Faith Formation Registration 22/23 New

New Family Registration

2022-2023
Child's Full Name*

First Name Middle Name Last Name
Grade in Fall*
Gender*
Date of Birth:*

MonthDay Year
City of Birth*
State of Birth*
A copy of the Sacramental Records must be on file at the Faith Formation Office!
Which Sacraments has your child received?

BaptismFirst Holy EucharistConfirmation
Date, City, & Parish of Baptism
Date, City, & Parish of First Holy Eucharist
Date, City, & Parish of Confirmation
Father's Name:*

First Name Last Name
Cell Phone #

Area Code Phone Number
Text?:

YesNo
Mother's Name:*

First Name Last Name Maiden Name
Cell Phone #
Text?:

YesNo
Address*

Street Address

Street Address Line 2

City

Zip Code
Family Email:*
Emergency Contact:*
Relation to Student:*
Cell Phone #*
Other adults allowed to pick-up student:
List any other adults (besides the listed parents) that can pick up the student.

So that we can best serve your child, please list any known conditions and/or allergies that we should be made aware of:*
I.E. Learning Disabilities, Allergies, Medications, Medical, Physical, Emotional, Behavioral, etc.
Primary Doctor's Name:*

First Name Last Name
Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Insurance Company:
Card and/or Group #
Phone Number*

Area Code Phone Number
I consent that my child(ren)'s photo may be taken during programming events at PBVM and that they may be used in the bulletin or on the website:*

YesNo
CIRCLE OF GRACE PERMISSION: The Bishops’ Charter for the Protection of Children and Youth and the Safe Environment Policies of the Diocese of Sacramento require that all children in our schools and faith formation programs be given Safe Environment training that is age-appropriate and in accord with Catholic moral principles. The Diocese of Sacramento provided this training through the Circle of Grace curriculum.
Circle of Grace Permission:*

I consent my child to participate in the Circle of Grace lessonI do not wish my child to participate in the Circle of Grace training and acknowledge that Safe Environment training materials have been offered to me.
By signing below, I request the above-named participant be allowed to attend church realted activites with Presentation of the Blessed Virgin Mary Catholic Church. I, the parent/guardian of the above named student do hereby give permission for him/her to attend Faith Formation/Sacramental Preparation classes and to be treated for a medical emergency in my absence while participating in the Faith Formation program. The adult supervisor may act as an agent in my absence.
Signature of Parent/Guardian:*

Registration Cost

One Child$85.00

Quantity

Holy Eucharist Sacrament Fee (2nd Grade)$30.00

Confirmation Sacrament Fee (8th Grade)$30.00

Enter coupon

Total $0.00

loading smart payment buttons...

Should be Empty:

New Family Registration