FF Registration form 2022

The Parish of St. Mary 39 Walnut Street, Onconta, New York 13820 607-432-3920 www.smeconeonta.org

Faith Formation Registration Form

CONTACT INFORMATION (Please print legibly) This information is used for the Faith Formation program only and will not be shared with anyone else.
Parent/Guardian Name(s)
Address
Home phone
Cell Phone
Email Address
example@example.com
CHILDREN (if more space is needed, please use back of form)
Name
DOB
Baptism: parish & date

Month Day Year
Date
School & grade
Name
DOB
Baptism: parish & date

Month Day Year
Date
School & grade
Name
DOB
Baptism: parish & date

Month Day Year
Date
School & grade
ADDITIONAL ADULTS you would like to have included in digital mailings (e.g., grandparents, extended family members, babysitters, college siblings)
Name and Email Address
example@example.com
Name and Email Address
example@example.com
I hereby authorize and give my consent for the taking of pictures (moving or still) of my child/ren

and further give my permission for their reproduction for teaching purposes, news

releases, publication, and/or community awareness programs.
Signature/ Date/ Relationship

Clear
Are there family or educational circumstances that we should be aware of in supporting the family?
Should be Empty: