Shrine of St. Anne Family Faith Formation Registration
Pre-School (age 4), Kindergarten, Grades 1-12
Are you a registered parishioner at Shrine of St. Anne's:
Yes
No
**If "NO," where are you registered?
Is this your child's first year in a Faith Formation Program?
Yes
No
**If "NO," where did they attend Faith Formation last school year?
Father's First/Last Name:
Religion:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Mother's First/Last Name:
Religion:
Phone:
Format: (000) 000-0000.
Email:
example@example.com
Emergency Contact Name:
Phone:
Format: (000) 000-0000.
Relationship with Child:
Child(ren)'s Information
Rows
CHILD'S FIRST & LAST NAME
M/F
BIRTHDAY
GRADE
1
2
3
4
Child 1 Sacraments Received (Check all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Child 2 Sacraments Received (Check all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Child 3 Sacraments Received (Check all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Child 4 Sacraments Received (Check all that apply)
Baptism
Reconciliation
Eucharist
Confirmation
Allergies or Special Needs: (Please specify for each child)
Sacramental Preparation is in addition to the regular Family Program. Please fill out a separate Sacramental Preparation registration form for your child if they are eligible to participate this year.
Child primarily lives with:
Both Parents
Mother
Father
(Name and Relationship)
Primary Mailing Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
This is:
Both Parents' Address
Only Mother's Address
Only Father's Address
(Please Specify)
Photographic and Interview Release
I hereby grant consent and release to the Catholic Archdiocese of Denver and the staff of Shrine of St. Anne Parish in Arvada, Colorado to use my name and likeness, whether in still, motion pictures, audio and video tape: my photograph and/or reproductions of me including my voice (which includes commentary, remarks, and/or recordings); my features, with or without my name, for promotional purposes involving the Archdiocese of Denver and the Shrine of St. Anne parish, for news and/or other usage on the Shrine of St. Anne website or The Denver Catholic Register or other media (which includes internet, print, radio, television), except for endorsement of any commercial products.
These items may be used without limitation or reservation of any fee.
Minors cannot consent to media interviews or waive their privacy right. These decisions must be made by parents/guardians; therefore, this release form must be signed by parents/guardians when the individual is a minor.
Please initial here if you DO NOT grant consent and release.
Please initial here if you DO grant consent and release. Please fill in the following information for your children. Form must be signed by a parent or guardian.
Student(s) Printed Name (s)
Grade(s)
Printed Name of Parent/Guardian (if student is a minor)
Address of Parent/Guardian
Parent/Guardian Signature
Date
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