TK to 12th Grade Faith Formation

TK to 12th Grade Faith Formation

2025-2026 Registration Form
Welcome to St. Joseph the Worker, Loma Linda Faith Formation Program. Each year you will need to complete a current registration form for your family. If you have not yet submited copies of your children's Birth, Baptism or 1st Communion Certificates please use this form to do so or email the Catechetical Office.

If you need to register more than 3 children please fill out an additional form. We will contact you 24-48 business hours after your form is received.
Family Information
Guardian 1 Name*

First NameLast Name
Guardian 1 Cell Phone*
Please enter a valid phone number.
Guardian 1 Email*
example@example.com
Guardian 1 Relationship to Student (s)*
Guardian 2 Name

First NameLast Name
Guardian 2 Cell Phone
Please enter a valid phone number.
Guardian 2 Email
example@example.com
Guardian 2 Relationship to Student(s)
Family Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your family registered at St. Joseph the Worker? $40 fee for families not registered at our parish*

YesNo, registered at different parishNo, not registered at any parish
Are you interested in Volunteering in our Faith Formation Classes?*

YesNo
Are you interested in hearing more about Home School options?*

YesNo
Are you interested in a payment plan?*

YesNo
Student Information
Student 1 Name*

First NameLast Name
Student 1 Birthdate*

MonthDayYear
Date
Student 1 Grade 25-26 year*
Please list any food, medication or environmental allergies student 1 has*
If none, please type N/A
Please list any physical or mental disabilities student 1 has.*
If none, please type N/A
Please select which Sacraments Student 1 has received already.*

BaptismConfessionCommunionConfirmationNone
Please upload copies of Student 1's Sacrament & Birth Certificates

Cancelof
Student 2 Name

First NameLast Name
Student 2 Birthdate

MonthDayYear
Date
Student 2 Grade 25-26 year
Please list any food, medication or environmental allergies student 1 has
If none, please type N/A
Please list any physical or mental disabilities student 2 has.
If none, please type N/A
Please select which Sacraments Student 2 has received already.

BaptismConfessionCommunionConfirmationNone
Please upload copies of Student 2's Sacrament & Birth Certificates

Cancelof
Student 3 Name

First NameLast Name
Student 3 Birthdate

MonthDayYear
Date
Student 3 Grade 25-26 year
Please list any food, medication or environmental allergies student 1 has
If none, please type N/A
Please list any physical or mental disabilities student 2 has.
If none, please type N/A
Please select which Sacraments Student 3 has received already.

BaptismConfessionCommunionConfirmationNone
Please upload copies of Student 3's Sacrament & Birth Certificates

Cancelof
Emergency Contact
Emergency Contact Name*

First NameLast Name
Relationship to student(s)*
Emergency Cell*
Please enter a valid phone number.
Annual Medical Release 2025-20256

Diocese of San Bernardino
By Signing this form I agree that I have fully answered this Medical Release Form to the best of my knowledge. I also understand that in the event medical intervention is necessary, every attempt will be made to contact immediately the persons listed on this form. If I cannot be reached in any emergency during Faith Formation Classes, I give my permission to the physican selected by the actvity leader to hospitalize in order to secure medical treatment, anesthesia, or surgery for my child(ren) as deemed necessary.
Name of Medical Insurance Carrier*
Name of Policy Holder*
Policy #*
Group #*
Preferred Hospital*
Primary Physician*
Media Release
Please check your media preference:*

I give permission for St. Joseph the Worker Church to include photos and/or videos of my child(ren) from church events in St. Joseph the Worker Church publications including media presentations, brochures, bulletin boards, church website or church bulletin.I DO NOT give permission for St. Joseph the Worker Church to include photos and/or videos of my child(ren) from church events in St. Joseph the Worker Church publications including media presentations, brochures, bulletin boards, church website or church bulletin.
Signature*

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TK to 12th Grade Faith Formation

Family Information

Student Information

Emergency Contact

Annual Medical Release 2025-20256

Media Release