GSIC FF Registration

2nd Child's Information
Name

First NameLast Name
Biological Sex
Date of Birth

MonthDayYear
Date
Grade (fall 2026)
Please check the Sacraments this child has already received
Does this child have any allergies or medical conditions we need to be aware of? If yes, please list.
Do you need to add other children?

3rd Child's Information
Name

First NameLast Name
Biological Sex
Date of Birth

MonthDayYear
Date
Grade (fall 2026)
Please check the Sacraments this child has already received
Does this child have any allergies or medical conditions we need to be aware of? If yes, please list.
Do you need to add other children?

4th Child's Information
Name

First NameLast Name
Biological Sex
Date of Birth

MonthDayYear
Date
Grade (fall 2026)
Please check the Sacraments this child has already received
Does this child have any allergies or medical conditions we need to be aware of? If yes, please list.

Medical and Photo Release
Simple Medical Release (Must be completed annually) I hereby grant to Church of the Good Shepherd/Immaculate Conception agent(s) the right to act in my place under conditions of medical emergency. This authorization includes the right to consent to, make judgments concerning the medical care, and treatment of the named student(s) in emergency situations. It is my understanding that I will be notified as soon as possible after any use of this authorization is made.
Signature of Parent or Guardian
Date

MonthDayYear
Date
PARENTS ARE FIRST CONTACT IN AN EMERGENCY, IN THE EVENT WE CANNOT CONTACT A PARENT PLEASE INDICATE SOMEONE OTHER THAN A PARENT TO CONTACT IN CASE OF EMERGENCY.
Emergency Contact Person
Phone #
Format: (000) 000-0000.
Relationship to childchildren
Photo Release Statement (Must be completed annually) I hereby grant permission for my child/children registered in Faith Formation at Church of the Good Shepherd/Immaculate Conception Church to be photographed/video recorded during Faith Formation events and activities; and for the resulting photographs and/or video recordings to be edited (if needed) and then be published/broadcast (church bulletin, website, etc) for the purposes of promoting the activities and events of the parish Faith Formation. CHILDREN'S NAMES WILL NOT BE PUBLISHED.
Do you agree to the photo release?
Signature of Parent or Guardian
Date

MonthDayYear
Date
Should be Empty:

Faith Formation Registration Church of the Good Shepherd / Mission: Immaculate Conception Church