St. Ann's Religious Education Student Enrollment & Release Form:

St. Ann's Religious Education Student Enrollment & Release Form:

Fill out the form carefully for registration
Number of Children you will be registering
Child # 1

First NameLast Name
Child 1 Grade*
Child 1 Birth Date*

MonthDayYear
Child 1-What sacrament(s) has your child received*

Baptism1st Communion & 1st Reconciliation
Child 1-Sacrament Certificate/s

Take a photo of the certificateUpload an image of the certificate
Take Photo
What sacrament is your child needing to prepare for this year?*

RCIC year 1 (7 years or older not baptized)RCIC year 2Eucharist year 1Eucharist year 2Confirmation year 1Confimation year 2Continuing religious education
Child # 2

First NameLast Name
Child 2 Grade*
Child 2 Birth Date*

MonthDayYear
Child 2-What sacrament(s) has your child received*

Baptism1st Communion & 1st Reconciliation
Child 2- Sacrament Certificate/s

Take a photo of the certificateUpload an image of the certificate
Take Photo
What sacrament is your child needing to prepare for this year?*

RCIC year 1 (7 years or older not baptized)RCIC year 2Eucharist year 1Eucharist year 2Confirmation year 1Confimation year 2Continuing religious education
Child # 3

First NameLast Name
Child 3 Grade*
Child 3 Birth Date*

MonthDayYear
Child 3-What sacrament(s) has your child received*

Baptism1st Communion & 1st Reconciliation
Child 3-Sacrament Certificate/s

Take a photo of the certificateUpload an image of the certificate
Take Photo
What sacrament is your child needing to prepare for this year?*

RCIC year 1 (7 years or older not baptized)RCIC year 2Eucharist year 1Eucharist year 2Confirmation year 1Confimation year 2Continuing religious education
Child # 4

First NameLast Name
Child 4 Grade*
Child 4 Birth Date*

MonthDayYear
Child 4-What sacrament(s) has your child received*

Baptism1st Communion & 1st Reconciliation
Child 4-Sacrament Certificate/s

Take a photo of the certificateUpload an image of the certificate
Take Photo
What sacrament is your child needing to prepare for this year?*

RCIC year 1 (7 years or older not baptized)RCIC year 2Eucharist year 1Eucharist year 2Confirmation year 1Confimation year 2Continuing religious education
Child # 5

First NameLast Name
Child 5 Grade*
Child 5 Birth Date*

MonthDayYear
Child 5-What sacrament(s) has your child received*

Baptism1st Communion & 1st Reconciliation
Child 5-Sacrament Certificate/s

Take a photo of the certificateUpload an image of the certificate
Take Photo
What sacrament is your child needing to prepare for this year?*

RCIC year 1 (7 years or older not baptized)RCIC year 2Eucharist year 1Eucharist year 2Confirmation year 1Confimation year 2Continuing religious education
Child # 6

First NameLast Name
Child 6 Grade*
Child 6 Birth Date*

MonthDayYear
Child 6-What sacrament(s) has your child received*

Baptism1st Communion & 1st Reconciliation
Child 6-Sacrament Certificate/s

Take a photo of the certificateUpload an image of the certificate
Take Photo
What sacrament is your child needing to prepare for this year?*

RCIC year 1 (7 years or older not baptized)RCIC year 2Eucharist year 1Eucharist year 2Confirmation year 1Confimation year 2Continuing religious education
Parent & Guardian Information
Mother's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Father's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

First NameLast Name
Phone Number
Please enter a valid phone number.

Program Details
I understand that 1st Communion and Confirmation is a 2 year program

I ACCEPT
As a family we will attend __________ number of family Faith Encounter events at St. Ann's

I ACCEPT
Our family understands that weekly Mass attendance and days of obligation are required.

I ACCEPT
Registration fee is $25.00 per child. I agree that payment needs to be made by the first day of class. Details to follow.

I ACCEPT
Medical Dietary Questions

PLEASE READ THE FOLLOWING CAREFULLY BEFORE SIGNING ACKNOWLEDGEMENT AND RELEASE AUTHORIZATION FOR MEDICAL TREATMENT:
Physical Condition: Please list any non-allergy physical/medical conditions that would be helpful for us to know about this child.
Medications: Please list the medications and dosage your child is currently receiving, along with any special instructions.
Food Requests: Please indicate any dietary requests due to your child’s preferences, religious practice, lactose intolerance, food sensitivity, or treatment for a behavioral condition. The following requests are NOT due to a food allergy:
Allergies: Has your child been tested and diagnosed for a food allergy by a health care professional? Is yes, please state the allergies below.
Stings: Our policy is to immediately administer diphenhydramine (Benadryl) to any student who is stung by a insect for the first time, has known allergic reactions or displays symptoms of a systemic reaction. If you choose to opt out, we will need to have a conversation before programming begins.

I ACCEPTI OPT OUTLET'S TALK MORE
Miscellaneous: Is there anything else that you believe it is important we know in regards to your child’s participation in this program? If so, please describe:

I HAVE READ THE AGREEMENT, FULLY UNDERSTAND IT, AND GRANT PERMISSION FOR MY CHILD TO PARTICIPATE IN THE PROGRAM IDENTIFIED ABOVE.
Date

MonthDayYear
Date
Should be Empty:

St. Ann's Religious Education Student Enrollment & Release Form:

Parent & Guardian Information

Program Details

Medical Dietary Questions