IC Faith Formation Registration

Immaculate Conception Faith Formation 2018-2019

Please complete form for as many children as will be attending. This is a secure form submission created by JotForm. Supply as much additional information as you are comfortable with.
Family Last Name*
Family Name
Mailing Address*

Street Address or PO Box

Street Address Line 2

CityState

Zip Code
Primary Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone Number
Email Address:
HIGHLY Encouraged - Class cancellations and many other communications are done using email.
Father's First Name
Last Name
Mother's First Name
Last Name
Who else is authorized to pick up your student(s)?
Please list the names of others you give permission to, to pick up your student(s) after class.
Emergency Contact
Emergency Contact Phone Number

Area CodePhone Number

Questions - Comments
Does your child have any special needs, medical concerns or allergies? Please explain.
Enter the message as it's shown*
The annual cost is $20 per Child or $40 Max per Family.

Please make checks payable to Immaculate Conception Church, and submit payment by the end of September.

Thank you and may God bless you.
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Immaculate Conception Faith Formation 2018-2019