Faith Formation/Sacramental Prep 2026 - 2027 Registration Form

Director of Religious Education - Rosie Beasley

Cell Phone - 850-321-3850

Email - rbeasley@bsctlh.com

Youth Confirmation Coordinator - Misha Eaton

Cell Phone - 248-795-3964

Email - teaton@bsctlh.com

Class Time: Sundays - 9:15 am - 10:15 am

Submit one form for each child.

Student Name

First NameLast Name

Grade for 2026-2027 Year

Birth Date

MonthDayYear

Gender

School

Father's Name

Father's Address

Street Address

Street Address Line 2

CityState

Zip Code

Mother's Name

Mother's Address - Fill out only if different from Father's Address

Street Address

Street Address Line 2

CityState

Zip Code

Child lives with

Other

Preferred E-mail

Father's Cell Phone

Area CodePhone Number

Mother's Cell Phone

Area CodePhone Number

I am interested in helping/substituting

MEDICAL INFORMATION Please list all information pertaining to allergies, diet, special medications, health conditions or any other information necessary in an emergency situation. N/A for none

Medications and dosage my child is taking: N/A for none.

Use a separate line for each medication

Insurance Carrier:

Name of Policy Holder

Relation to Youth

Policy Number

Group Number

My child is allowed to be given the following medication:

Ibuprofen (Advil)

Acetaminophen (Tylenol)

Benedryl

Tums/Pepto Bismol/Antacid

PERMISSION

If you would like your youth to participate in parish activities, please sign and return the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by your youth.

In consideration for the opportunity for my child to participate in parish activities, and fully recognizing that such an undertaking involves an element of risk, we assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify and agree to hold harmless the Diocese of Pensacola-Tallahassee and Blessed Sacrament Parish, and their employees, agents, volunteers, and other persons acting on their behalf. Neither the Diocese of Pensacola-Tallahassee, Blessed Sacrament Parish, nor said agents, employees, or volunteers, shall be held financially responsible for any injury, illness or death incurred as a direct or indirect result of this activity. We the undersigned have read this release and understand all its terms and execute it voluntarily and with full knowledge of its significance.

EMERGENCY MEDICAL TREATMENT:

In the event of an emergency, I/we hereby authorize the Diocese of Pensacola-Tallahassee, and Blessed Sacrament Parish, through its authorized representatives, to transport my child to a hospital or other doctor’s office or medical facility for emergency medical attention. I/We additionally authorize such representatives of the Diocese and/or School to obtain and give consent to whatever medical treatment the representative deems necessary, including the administering of anesthetic and surgery, and do hereby release the Diocese and Blessed Sacrament Parish, and their authorized representatives from any and all claims which may arise from the above-referenced obtaining and consenting to medical treatment. I/We wish to be advised, if possible, prior to the providing of any non-emergency medical treatment by any physician or hospital.

If I/we are unable to be reached, please contact the following:

Emergency contact (in case parent is unable to be contacted) and relation to participant

Phone Number

Sacraments Received:

Baptism

First Reconciliation

First Holy Communion

Confirmation

Are you planning to have your youth Confirmed at the May 16, 2027 Confirmation Mass?

By clicking the box below, I hereby give permission for photographs and/or video in which my child appears in to be used by the church in printed and/or electronic media, including the church's website and bulletin. It is the promise and commitment of the Diocese of Pensacola-Tallahassee to use pictures and videos from Diocesan and/or parish youth events in a dignified and respectful manner. I hereby authorize the Diocese of Pensacola-Tallahassee, including its parishes, schools, and institutions (hereinafter referred to as “Diocese of Pensacola-Tallahassee”) to use, prepare, reproduce, record, video tape, publish, distribute, broadcast, electronically store, and exhibit my name, image, portrait, likeness, words, and/or voice in connection with interviews, sessions, or events conducted, sponsored, or arranged by the Diocese of Pensacola-Tallahassee and its employees, volunteers, and agents. I acknowledge that any notes, photographs, motion pictures, digital images, recordings, or other media format taken of me will become the property of the Diocese of Pensacola-Tallahassee, and I specifically waive any right to compensation for the foregoing. I understand that my likeness, name, image, or voice may be used by the Diocese of Pensacola-Tallahassee without limitation for any professional purpose, now or in the future, and I consent to the same. This permission extends to any authorized print or broadcast media organization that may participate in such preparation, use, reproduction, publication, or distribution. I release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I also hereby waive any right I may have to inspect and approve in advance the photographs, videos, sound recordings, or publications or media in which I am included. I agree to release the Diocese of Pensacola-Tallahassee and its employees, volunteers, agents and designees from any liability by virtue of the use of the photographs or video recordings, regardless of any blurring, distortion, optical illusion, or alteration which may occur when the photographs or videos are taken, printed, or displayed. A copy of this release shall be as valid and enforceable as the original.

Sign Here:

Religious Education/Sacramental Prep Annual Payment

Religious Ed/Sacramental Prep Payment (1 Child)$40.00

Total $0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

Religious Education & Sacramental Prep 2026-2027 Registration

Religious Education/Sacramental Prep Annual Payment*

Payment Methods

Religious Education/Sacramental Prep Annual Payment