Faith Formation Registration Form

St. Mary Faith Formation

School Year 2022-23 $25 per student due September 18th to the Office or Kaite or Amanda Memo line Faith Formation
Guardian 1*

First NameLast Name
Guardian 1 *
Religion
Guardian 2

First NameLast Name
Guardian 2
Religion
Parent E-mail*
example@example.com
Mobile Number*
Additional Mobile Number
Student(s) Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
MarriedSingleDivorcedOther Situation
YesNo
Food Allergies List Whole Family or By Student if they are different.*
Does your child require any classroom modifications? Answer Yes or no and we will contact you for further information
Student 1 Full Name*

First NameMiddle NameLast Name
Student 1 Grade Level 2022-23*
Student 1 Birth Date*

MonthDayYear
Students in Program*
Student 2 Full Name

First NameMiddle NameLast Name
Student 2 Grade Level 2022-23
Student 2 Birth Date

MonthDayYear
Student 3 Full Name

First NameMiddle NameLast Name
Student 3 Grade Level 2022-23
Student 3 Birth Date

MonthDayYear
Student 4 Full Name

First NameMiddle NameLast Name
Student 4 Grade Level 2022-23
Student 4 Birth Date

MonthDayYear
Student 5 Full Name

First NameMiddle NameLast Name
Student 5 Grade Level 2022-23
Student 5 Birth Date

MonthDayYear
Student 6 Full Name

First NameMiddle NameLast Name
Student 6 Grade Level 2022-23
Student 6 Birth Date

MonthDayYear
Person to contact in case of emergency:*
Non Guardian
Relationship*
ex. Grandparent, friend, neighbor, etc.
Phone Number*
I Grant Medical ConsentNo Medical Consent
I Grant Media ConsentNo Media Consent
Number of Students in the Program:
Registration fee is $25 per student payment due to Office or Katie Hohenbrink or Amanda Stechschulte Memo line: Faith Formation
Amount due for Registration Fees
Fees are due to the office or Katie Hohenbrink or Amanda Stechschulte by September 18, 2022
Should be Empty:

St. Mary Faith Formation