Faith Formation Registration 2022-23 Register for Faith Formation online! If you have any questions, please contact the Faith Formation Office. Faith Formation Registration "*" indicates required fields Family InformationParent 1 Name* First Last Parent 2 Name First Last Parent 1 Cell Phone*Parent 2 Cell PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Add another parent who has a different address? Yes No Parent Name First Last Parent Name First Last Parent 1 Cell PhoneParent 2 Cell PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email We are registered parishioners of Blessed Sacrament Assumption St. Brigid Other What church do you belong to? I am interested in volunteering with Elementary Middle School High School Student InformationName* First Last Student Email (if applicable) Gender* Date of birth* Month Day Year Age* School in the fall* Grade*Preschool (4yr)K1st2nd3rd4th5th6th7th8th9th10th11th12thYM Friend Request Mark Sacraments NeededPlease select all that apply Baptism First Eucharist Confirmation Reconciliation Allergies & Other Medical InformationMedicine son/daughter is now takingList Special NeedsAdd another child? Yes No Name* First Last Student Email (if applicable) Gender* Date of birth* Month Day Year Age* School in the fall* Grade*Preschool (4yr)K1st2nd3rd4th5th6th7th8th9th10th11th12thYM Friend Request Mark Sacraments NeededPlease select all that apply Baptism First Eucharist Confirmation Reconciliation Allergies & Other Medical InformationMedicine son/daughter is now takingList Special NeedsAdd another child? Yes No Name* First Last Student Email (if applicable) Gender* Date of birth* Month Day Year Age* School in the fall* Grade*Preschool (4yr)K1st2nd3rd4th5th6th7th8th9th10th11th12thYM Friend Request Mark Sacraments NeededPlease select all that apply Baptism First Eucharist Confirmation Reconciliation Allergies & Other Medical InformationMedicine son/daughter is now takingList Special NeedsAdd another child? Yes No Name* First Last Student Email (if applicable) Gender* Date of birth* Month Day Year Age* School in the fall* Grade*Preschool (4yr)K1st2nd3rd4th5th6th7th8th9th10th11th12thYM Friend Request Mark Sacraments NeededPlease select all that apply Baptism First Eucharist Confirmation Reconciliation Allergies & Other Medical InformationMedicine son/daughter is now takingList Special NeedsEmergency/Insurance InformationEmergency Contact Name* Emergency Contact Phone*Emergency Contact Relationship to child(ren)* Family Physician* Physician Phone*Health Insurance Company* Policy/Contract Number* Do any of your children have different insurance information? Yes No Child(ren)'s Name(s)Family Physician Physician PhoneHealth Insurance Company Policy/Contract Number Medical ReleaseConsent*As parent(s) or legal guardian(s) of the child(ren) listed above, I (we) give the Blessed Sacrament designated adult supervisor permission to authorize medical treatment for my son/daughter as needed. I further consent that as parent or legal guardian I remain fully responsible for any legal responsibility that may result from any personal action taken by the named participant. I also understand and give permission for my youth to meet in a small group that may meet in a parishioner's home, or St. Brigid Parish, or Assumption BVM Parish. I have read and agree to the statement of medical release.E-Signature*By typing your name, you are signing this Form electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Form. By typing your name using any device, means or action, you consent to the legally binding terms and conditions of this Form. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and Blessed Sacrament. You are also confirming that you are the parent/guardian authorized to enter into this Agreement. CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
Register for Faith Formation online! If you have any questions, please contact the Faith Formation Office.