St. John Fisher Religious Education Registration Form 2026-2027

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Number of children to register:
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Medical Treatment Release

*One form is needed for each registered child. To Whom It May Concern: As parent/guardian, I do hereby authorize the treatment of a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.
Child's Name

First NameLast Name
Relationship to you
Birth Date

MonthDayYear
Date
Gender
Medical Info
Event for which release is intended:
Emergency Information
Mother's Name:

First NameLast Name
Mother's Emergency Phone:
Format: (000) 000-0000.
Father's Name:

First NameLast Name
Father's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Emergency Contact Name

First NameLast Name
Alternate Emergency Contact Relation to Child
Alternate's Emergency Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Physician Information
Family Physician Name:
Family Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Family Physician Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Health Insurance Data
Insurance Company
Policy
Group Number
Contract
I further authorize the person who presents the minor to sign the Acknowledgment of Receipt of Notice Privacy Rights that may be presented by the physician or health care facility. This authorization is completed and signed with the sole purpose of authorizing emergency medical treatment, only after a reasonable effort has been made to reach me. I acknowledge that it is my responsibility to inform the Religious Ed office if any of this information changes. By signing my name below, I am agreeing to the above listed medical waivers for the purposes of St. John Fisher Chapel University Parish Religious Education 2026/2027.
Full Name of Signer
First Last
Current Date

MonthDayYear
Date

Media Release:

One per Family
I (We) give OR do not give permission for St. John Fisher Chapel University Parish, Auburn Hills, MI, to publish or disclose in parish-related newsletters, brochures, websites, or other media-related vehicles, any photos, videos, audios, or other materials in which I or my child(ren) may have appeared, spoken, written, or otherwise been represented. This release will be kept on file. It may be revoked at any time. Please select one:
Parent or Legal Guardian Name:

Parent or Legal Guardian First NameParent or Legal Guardian Last Name

Tuition and Fees

Full Tuition and Sacramental Fees must be paid at time of registration. A families inability to pay should never stop them from attending. If these rates are not viable for your family at this time please contact: mcguire.judie@grizzlycatholic.org Upon submission you will redirected for payment.
REGISTRATION WILL BE PROCESSED UPON PAYMENT
Upon submission you will be taken to a payment page to be utilized for both online and offline payments. If you encounter any trouble, a link to the payment page is included in the email confirmation for this form.
NOTICE: A copy of the yearly 2026/2027 calendar will be attached to your registration confirmation email. PLEASE MAKE SURE TO MARK THIS IN YOUR EMAIL FOR LATER REFERENCE.
I have read and understand the above statements on tuition payment page and program calendar.
Should be Empty:

Heading

St. John Fisher Religious Education Registration Form 2026-2027

Student Information

Volunteer Opportunity

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Medical Treatment Release

Emergency Information

Physician Information

Health Insurance Data

Media Release:

Tuition and Fees

REGISTRATION WILL BE PROCESSED UPON PAYMENT

NOTICE: A copy of the yearly 2026/2027 calendar will be attached to your registration confirmation email. PLEASE MAKE SURE TO MARK THIS IN YOUR EMAIL FOR LATER REFERENCE.