WNRE Registration Form

WNRE Registration Form

2025-2026
Parent/Guardian Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian E-mail*
example@example.com
Mobile Number*
Work Number
Home Number
Are you a registered parishioner?*

YesNo

Child #1*

First NameLast Name
Grade in 2025-2026 school year*
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?*

YesNo

Child #2

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?

YesNo

Child #3

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?

YesNo

Child #4

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.
Would you like to register another child?

YesNo

Child #5

First NameLast Name
Grade in 2025-2026 school year
Allergies, Food restrictions, Medical information, etc.

Sacraments
Will any registered child be receiving 1st Communion or Confirmation?*

YesNo

Sacramental Information
Child #1 Full Legal Name*

First and Middle NameLast Name
Which Sacrament will your child be receiving?*

First CommunionConfirmation
Date of Baptism*

MonthDayYear
Date
Church of Baptism *
City/State of Church of Baptism*
We are required to have a copy of the Sacramental Record, which is kept at the Church of Baptism. If your child was not baptized at St. Michael, please contact your child's Church of Baptism and ask for a Sacramental Record to be sent to:

St. Michael Catholic Church

519 Jefferson Blvd.

Greenfield, IN 46140

**NO COPIES of Baptismal Certificates will be accepted. Records must be mailed from Church of Baptism to St. Michael** If your child WAS baptized at St.Michael, Greenfield, IN then you will not need to contact the church. If you have further questions about baptism certificates or if your child was not baptised in a Catholic Church, please send an email to Jennifer Beyer at re@stmichaelsgrfld.org
I will/have contacted the Church of Baptism.The church was not Catholic. You will be contacted by Jennifer Beyer.
Do you have another child receiving 1st Communion or Confirmation?

YesNo

Sacramental Information
Child #2 Full Legal Name*

First and Middle NameLast Name
Which Sacrament will your child be receiving?*

First CommunionConfirmation
Date of Baptism*

MonthDayYear
Date
Church of Baptism *
City/State of Church of Baptism*
We are required to have a copy of the Sacramental Record, which is kept at the Church of Baptism. If your child was not baptized at St. Michael, please contact your child's Church of Baptism and ask for a Sacramental Record to be sent to:

St. Michael Catholic Church

519 Jefferson Blvd.

Greenfield, IN 46140

**NO COPIES of Baptismal Certificates will be accepted. Records must be mailed from Church of Baptism to St. Michael** If your child WAS baptized at St.Michael, Greenfield, IN then you will not need to contact the church. If you have further questions about baptism certificates or if your child was not baptised in a Catholic Church, please send an email to Jennifer Beyer at re@stmichaelsgrfld.org
I will/have contacted the Church of BaptismThe church was not Catholic. You will be contacted by Jennifer Beyer
Do you have another child receiving 1st Communion or Confirmation?*

YesNo

Sacramental Information
Child #3 Full Legal Name*

First and Middle NameLast Name
Which Sacrament will your child be receiving?*

First CommunionConfirmation
Date of Baptism*

MonthDayYear
Date
Church of Baptism *
City/State of Church of Baptism*
We are required to have a copy of the Sacramental Record, which is kept at the Church of Baptism. If your child was not baptized at St. Michael, please contact your child's Church of Baptism and ask for a Sacramental Record to be sent to:

St. Michael Catholic Church

519 Jefferson Blvd.

Greenfield, IN 46140

**NO COPIES of Baptismal Certificates will be accepted. Records must be mailed from Church of Baptism to St. Michael** If your child WAS baptized at St.Michael, Greenfield, IN then you will not need to contact the church. If you have further questions about baptism certificates or if your child was not baptised in a Catholic Church, please send an email to Jennifer Beyer at re@stmichaelsgrfld.org
I will/have contacted the Church of BaptismThe church was not Catholic. You will be contacted by Jennifer Beyer

Medical Information
Name of an additional parent/guardian or emergency contact in case the primary parent/guardian is not able to be reached.*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Name of Family Physician or Medical Provider*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Medical Insurance Company (type "uninsured" if coverage in not in place)*
Policy Number

Authorizations and Acknowledgements
I hereby authorize St. Michael Catholic Church its agents to utilize photographic and/or video images of me or my child taken during this event. In giving my consent, I hereby indemnify and hold harmless St. Michael Catholic Church and Totus Tuus and its agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph and/or video of me or my child be used.*

YesNo
Medical Authorization:

I understand that St. Michael Catholic Church assumes no responsibility for accidents which may occur in association with diocesan events and activities. I agree to use my/our personal insurance to cover any such incidents. I understand that, in the event medical intervention is needed, every attempt with be made to contact the persons listed above. In the event those individuals cannot be reached, I hereby give permission to the physician or any other qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injections, anesthesia, or surgery for the Participant(s) as deemed necessary.
Relase of Liability for Youth and Adults:

I understand all reasonable safety precautions will be taken at all times by St. Michael Catholic Church, its leaders, employees and volunteers during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless St. Michael Catholic Church, its leaders, employees, and volunteer staff from any and all claims arising from or in connection with attending this event.
Code of Behavior for Youth:

I agree to abide by and/or instruct my child to abide by all rules and regulations as outlined by the WNRE classroom educator. I agree that if I/Participant fail(s) to abide in any way by the rules, that I/Participant can be dismissed from class and sent home immediately.

Futhermore, if my child is recieving a scrament, he/she will meet all the requirements communicated at the beginning of the year. I understand that if requirements are not met then my child's sacrament may be delayed.
Parent/Guardian Signature*

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Payment Information
The cost to attend WNRE is as follows:
- 1 participant - $40
- 2 participants - $70
- 3 or more participants - $90
Fees may be paid with a debit/credit card below or by check made payable to St. Michael. Check payments may be brought to the Parish Office or dropped in the weekend collection basket in a marked envelope. Cash/Check payment is due by October 1.

Financial assistance is available. Reach out to Jennifer Beyer at re@stmichaelsgrfld.org or Fr. Aaron Jenkins for more information.
Payment options*

Debit/Credit cardCheck/CashFinancial assistance needed

Debit/Credit Card Checkout

1 participant

$40.00

2 participants

$70.00

3 or more participants

$90.00

Total

$0.00

Credit Card

Should be Empty:

WNRE Registration Form

Sacraments

Sacramental Information

Sacramental Information

Sacramental Information

Medical Information

Authorizations and Acknowledgements

Payment Information

Credit Card