2026 Daughters of St. Therese Registration

DAUGHTERS OF ST. THERESE
Registration Form
We welcome all girls who have received their First Communion to serve as a Daughter of St. Therese.
Basic Information
Server's Name
Date of Birth

MonthDayYear
Date
Server's Grade Level in 2026-2027
Date Server received First Communion

MonthDayYear
Date
Contact (Parent/Guardian) Name
Contact's Relation to Server
Contact Phone Number
Format: (000) 000-0000.
Contact Email
example@example.com
Server Availability
(Mark all Masses Server can serve)
Server Availability

Other
Server and Parent Commitment
As a Daughter of St. Therese, I commit to:
- Serving at assigned masses with dignity and love
- Arriving 30 minutes prior to Mass.
- Finding a replacement and notifying Theresa Becker if I am unable to serve on my assigned day.
Parent/Guardian Signature
Server Signature

REGISTRATION FORM FOR
Daughter Days
To register your daughter for Christ the King's Daughter Days on June 25 & 26, 2026, please complete the form below.
Please plan to have your child arrive at Christ the King no later than 8:00 AM on both days. The children should be picked up at 4:00 PM on June 25 and 5:00 PM on June 26.
We welcome all girls who have received their First Communion and wish to serve as a Daughter of St. Therese.
Basic Information
Server's Name
Date of Birth

MonthDayYear
Date
Contact (Parent/Guardian) Name
Contact's Relation to Server
Contact Phone Number
Format: (000) 000-0000.
Contact Email
example@example.com
I am a Parishioner at:
Dietary Restrictions or Medications:
Shirt Size
Youth Sizes
Women's Sizes
Server and Parent Confirmation
By signing below, I am confirming my desire to participate in Christ the King's Daughter Days.
Parent/Guardian Signature
Server Signature

DAUGHTERS OF ST. THERESE
Media Release
Basic Information
Minor's Name
Date of Birth

MonthDayYear
Date
Contact's (Parent/Guardian) Name
Contact's Relation to Server
Contact's Email
example@example.com
Contact Phone Number
Format: (000) 000-0000.
I hereby grant Christ the King Church and the Archdiocese of Portland permission to publish still pictures, motion pictures, audio or video recording of the minor in order to promote and advance the mission of the Catholic Church and future events on its website/Facebook/posters. Christ the King Church along with the Archdiocese of Portland agree to take all necessary precautions and to not display any identifying information (name, age, etc.) for the child and adult whose image is used for this purpose. This permission will remain in effect for one year from the date written below unless revoked by written notice to Christ the King Church.
Parent/Guardian Signature
Date

MonthDayYear
Date

CHURCH/SCHOOL EVENT PERMISSION FORM FOR STUDENT/YOUTH
CONTACT PERSON
TO BE COMPLETED BY SPONSORING CHURCH OR SCHOOL
TO BE COMPLETED BY PARENT/LEGAL GUARDIAN
Child's Name:
Date of birth:

MonthDayYear
Date
Sex:
Person(s) to notify in case of an emergency:
Emergency Contact #1 Name:
Phone 1:
Format: (000) 000-0000.
Phone 2:
Emergency Contact #2 Name:
Phone 1:
Format: (000) 000-0000.
Phone 2:
Emergency Contact #3 Name:
Phone 1:
Format: (000) 000-0000.
Phone 2:
Family Physician:
Family Physician Phone:
Child Allergies (foods, drugs, insects, etc.):
Medications (name, dosage, reason):
Other information (injuries, special needs, etc.):
Insurance Carrier:
Group or ID:
I, the undersigned, give permission for my child to take part in the above off premises event and authorize the Church/School to provide transportation to and from the event. I also authorize the Church/School and its employees or chaperones to secure any and all necessary medical services for my child in the event of an accident or illness. Further, I agree to be solely responsible for payment for those services. Parent/Legal Guardian Name:
Child Name:
Parent/Guardian Signature
Date:
Should be Empty:

DAUGHTERS OF ST. THERESE