Faith Formation Registration 22/23- Returning

Faith Formation Registration

Returning Students 2022-2023
A COPY OF COMPLETED SACRAMENT CERTIFICATES MUST BE ON FILE WITH THE FAITH FORMATION OFFICE

Please fill out the information for each child and select which Sacraments they have received. *

	Child Full Name (Last, Middle, First)	M/F	Grade	Attended Last Year?	Birth Date	Baptism	Holy Communion	Confirmation
Child #1
Child #2
Child #3
Child #4

Address *

Street Address

Street Address Line 2

City

Zip Code
Family Email: *
example@example.com
Is this a new address from last year?

Yes No
Father's Name: *
Cell Phone #
Text?:

Yes No
Mother's Maiden Name: *

First Name Middle Name Maiden Name
Cell Phone #

Area Code Phone Number
Text?:

Yes No
Emergency Contact: *

First Name Last Name
Cell Phone # *

Area Code Phone Number
Relation to Student: *
Other adults allowed to pick up student
So that we can best serve your child, please list any known conditions 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
Phone Number *

Area Code Phone Number
Insurance Company:
Card/Group #
Address:

Street Address

Street Address Line 2

City

Zip Code
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 *

Yes No
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 lesson I 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.
Name Signing: *

First Name Last Name
Date *

Month Day Year
Date
Signature of Parent/Guardian *

Clear

Payment for Registration:

Registration $ 85.00

Please enter the number of children you are registering.

Quantity

First Holy Communion Sacrament Fee $ 30.00

per child in 2nd Grade

Quantity

Confirmation Sacrament Fee $ 30.00

per child in 8th Grade

Quantity

Enter coupon

Total $ 0.00

Should be Empty: