Faith Formation Registration 2023-24 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest 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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin 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. Media ReleaseDuring the course of the year we will be taking photographs, videotaping, and/or voice taping individuals.*This form allows you an opportunity to indicate if you do, or do not, want your child photographed, videotaped, and/or voice taped at various activities within the parish or on group outings outside of the parish. * Pictures may be used by Blessed Sacrament Parish to highlight current events in the following ways: Parish bulletin, website, brochures, and in PowerPoint slide shows.Please select one:*Yes, you have my persmissionNo, you do not have my permission.Student Name(s)*Please include the names of all students of your family who are registered for Faith Formation and Youth MinistryParent/Guardian E-Signature Date (This consent must be re-examined and signed each year)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CAPTCHANameThis field is for validation purposes and should be left unchanged.
