ELEMENTARY (K-5) FAITH FORMATION REGISTRATION FORM

St. Pius X & Visitation Parishes

ELEMENTARY (K-5) FAITH FORMATION REGISTRATION FORM
Family Information
Today’s Date

MonthDay Year
Date
Last Name*
Phone
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Father’s Name
Father's Religion
Mother’s Name
Mother's Religion
Family email address*
example@example.com
Additional email
example@example.com
Our family is registered at:
Parish Name
Did your child(ren) attend formation with us last year?

YesNoOther
Participant Information (Include child's last name if different from family name)
Child 1 Name

Child 1 info and sacraments celebrated

	Birth Date	Grade	Baptism	Communion	Confirmation
Child 1

Child 2 info and sacraments celebrated

	Birth Date	Grade	Baptism	Communion	Confirmation
Child 2

Child 3 info and sacraments celebrated

	Birth Date	Grade	Baptism	Communion	Confirmation
Child 3

In case of emergency, contact:
Emergency Contact Phone
Emergency Contact 2 (name)
Emergency Contact 2 Phone
I grant permission to publish a photograph of my child on Diocesan/ Parish websites including group photos:

YesNo
Please list any special circumstances (health, learning, family) that the leaders should be aware of:
Registration fee is $20 for first child, $15 for second child, $10 for third child. No fee beyond third child. Money is due no later than first day of formation. Checks can be made out to St. Pius X or Visitation.
Should be Empty:

St. Pius X & Visitation Parishes