Faith Formation Program
Registration Form
2022 - 2023

Family Last Name *

Primary Phone *

Father's Name *

First

Last

Father's Phone *

Father's Email *

Confirm Email

Mother's Name *

First

Last

Maiden Name *

Mother's Email *

Confirm Email

Mother's Phone *

Street Address *

Address Line 1

Address Line 2

City

State

Zip Code

EMERGENCY CONTACT

Person(s) authorized to pick up my child at Religious Ed classes, in the event that I can't be there at dismissal time.

Emergency Contact Name *

First

Last

Relation to Child *

Emergency Contact's Phone *

Emergency Contact Name *

First

Last

Relation to Child

Emergency Contact's Phone

All Children must be signed in and signed out by their Parents or Authorized Persons in the grade appropriate sign-in book in the classrooms. If your child is eligible to receive Sacraments this year, you must complete a "REGISTRATION FOR SACRAMENTAL PREPARATION" form, in addition to this Registration Form. Sacramental Preparation is separate from Religious Education. Please have a copy of all Sacramental Certificates with the Church Seal.

Number of Children being registered

CHILD(REN) INFORMATION

CHILD 1 INFORMATION

Child's Name *

First

Last

Date of Birth *

Birthplace *

School Grade in 2022-2023 *

RELIGIOUS EDUCATION DAY (Select One) *

FF Grade *

Baptism Date

Church

Reconciliation Date

Church

1st Eucharist Date

Church

Insurance Carrier

Policy/Group Number *

Student's Physician *

First

Last

Physician's Phone *

Allergies

Other Medical Concerns *

Sacramental Preparation Registration for
First Reconciliation & First Holy Eucharist
2022 - 2023
St. Faustina Catholic Parish

Name of Child *

First

Last

Date of Birth *

Father's Name *

First

Last

Mother's Name *

First

Last

Mother's Maiden Name *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent's Home Phone

Parent's Cell Phone *

Parent's Work Phone

Email *

Was your child baptized? *

School

Grade (2022-2023)

Faith Formation Grade

Photo/Image Release Form

I ...

Name *

First

Last

for valuable consideration received, and for being allowed access to Diocesan property, activities, or events, expressly assign to St. Faustina Catholic Church, Clermont, FL and the Diocese of Orlando, and to all of their current, former, and future agents and related entities (collectively, “the Diocese”), all rights, title and interest in, and to, the use of my and my child/ward’s image or likeness, including, but not limited to all videotape recordings, photographs, or audio recordings of, or made by, me and/or my child/ward on Diocesan property, during a Diocesan-sponsored event, or for any other Diocesan purpose (“the Property”). The Diocese shall have, without my consent, the right to assign its rights in the Property, in whole or in part, to any entity, parish, or school within the Diocese of Orlando.

I hereby irrevocably grant the Diocese perpetually and exclusively, the right to use and incorporate (alone or together with other materials), in whole or in part, the Property, in any Diocesan publication, news release, or for any other purpose. Further, I hereby authorize the reproduction, sale, lease, copyright, exhibition, broadcast and/or distribution of the Property without limitation for any purpose whatsoever, and I further waive all rights to any compensation for my and/or my child/ward’s appearance or participation in the Property. I understand and have been advised that photographs or videotape of participants may be used in publications, websites or other materials produced from time to time by the Office of Youth and Young Adult Ministry and/or the Diocese. Participants’ names would not be identified, however, without specific written consent. I further understand that the Diocese has no control over the use of photographs or film taken by media that may be covering the event in which my child(ren) participate(s).

I hereby waive any claims against and release the Diocese, its current, former, and future religious, employees, volunteers, agents, and successors and assigns from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that I and/or my child/ward may have against the Diocese in connection with the Property or the use of the Property.

This release shall not obligate the Diocese to use the Property or to use any of the rights granted hereunder, or to exhibit, distribute, or exploit the Property. I acknowledge that the Diocese cannot control all photographic access to its properties, and that my child/ward’s name may be printed with photos/images in various publications, including non-Diocesan publications.

I represent that I am eighteen years of age or older, and that I have read and understand the terms of this Assignment, Waiver, and Release.

Signature

Date *

Witness Name *

First

Last

Phone *

If applicable, name(s) of minor children/wards

Faith Formation Program
Returning Students
Registration Form
2022 - 2023

Tuition and Book Fees due at Registration: One child: $60.00; Two or more children: $10 additional for each.
Update any changes from last year:

Child's Name *

First

Last

School Grade in 2022-2023 *

Mother's Name *

First

Last

Maiden Name *

Father's Name *

First

Last

Father's Email *

Confirm Email

Change of Address

Address Line 1

Address Line 2

City

State

Zip Code

Change of Parent's Home Telephone Number

Change of Parent's Cell Telephone Number

Change of Family Status

Change of Emergency Contact Person

First

Last

Change of Authorized Person(s) to pick up your child at Church

First

Last

Change of Authorized Person(s) to pick up your child at Church

First

Last

Change of Any Medical Information

Does your child have any new allergies or chronic medical problems?

Was your child baptized? *

Has your child received First Confession and First Communion?

Other Changes we should be aware of?

Parent's Signature

Today's Date

St. Faustina Catholic Parish
Emergency Medical Form

Name of Child *

First

Last

Age *

MEDICAL INFORMATION

In the event a participant becomes ill or injured, I authorize St. Faustina Catholic Parish’s Parochial Administrator, Rev. Ramon Bolatete, or the Director of Faith Formation, Marylu Mariniello or representatives to obtain medical attention at a physician’s office, hospital or by an EMT or other emergency medical services. I understand that every effort will be made to reach me before medical permission is given to treat my child. The participant is covered by the following medical insurance:

Insurance Co. Name *

Group # *

Allergies *

Chronic Medical Problems *

Medications taken by child *

Other Important Medical Information *

Print name of Parent/Guardian *

Signature *

Today's Date *

Home Phone of Parent/Guardian *

Cell Phone of Parent/Guardian *

Work Phone of Parent/Guardian *

EMERGENCY CONTACT PERSON

WHEN PARENT/GUARDIAN CANNOT BE REACHED

In the case of an emergency, the parents / guardians will always be the first persons we try to contact. However, in the case that we are unable to contact the parents / guardians, we need to have some other adult that we can call. Please include the information below of the contact person you choose in the case that we are unable to reach you.

Name *

First

Last

Relationship *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Cell Phone *

Work Phone

Faith Formation Program Registration Form 2022 - 2023

EMERGENCY CONTACT

CHILD(REN) INFORMATION

Sacramental Preparation Registration forFirst Reconciliation & First Holy Eucharist 2022 - 2023 St. Faustina Catholic Parish

Photo/Image Release Form

Faith Formation Program Returning Students Registration Form 2022 - 2023

St. Faustina Catholic Parish Emergency Medical Form

MEDICAL INFORMATION

EMERGENCY CONTACT PERSON

Faith Formation Program
Registration Form
2022 - 2023

Sacramental Preparation Registration for
First Reconciliation & First Holy Eucharist
2022 - 2023
St. Faustina Catholic Parish

Faith Formation Program
Returning Students
Registration Form
2022 - 2023

St. Faustina Catholic Parish
Emergency Medical Form