Faith Formation 2022/23 Registration FAMILY FORM

Catechesis of the Good Shepherd

FAMILY CONTACT INFO

Family Last Name

Required*

Write the collective last name of the child's family

Parent Name

First Name*

Last Name*

Relationship to child

Required*

Parent Phone

Required* --

Enter the main phone number where we may reach you.

Parent Email

Required*

ALL communications will be sent to this email address.

Parent Address

Street 1*

Street 2

City*

State*

Zip*

Parent #2 Name

First Name

Last Name

Relationship to child

Parent #2 Phone

Parent #2 Email

Optional. Enter an additional email address if you would like communications sent to more than the primary address.

Emergency Contact

First Name*

Last Name*

In the event of an emergency and we are UNABLE TO CONTACT PARENTS OR LEGAL GUARDIANS, please provide an alternate Emergency Contact Person.

Relationship

Briefly describe the emergency contact's relationship to your child (Neighbor, Friend, Aunt, Uncle, Grandparent etc.)

Emergency Phone

Required* --

Please provide a phone number where we may reach your emergency contact in case of an emergency. Thank you!

ARE YOU REGISTERED AT HOLY FAMILY PARISH?

Parishioner Status
Required*

	Yes
	No
	I am not sure

If you are not yet a registered parishioner, or are unsure, please call the Parish Office at 425-822-0295.

PARENT ORIENTATION

	Every family is required to attend one orientation session. Please sign up for one date.
Parent Orientation	Required*	All families, new or returning, need at least one person to attend a program orientation.

FAMILY MEDICAL INFORMATION

	All information on this form will be kept confidential and only used in case of medical need or emergency.
Insurance Carrier	Required*
Policy Number	Required*
Physician Name	Required*	Please write the name of your child's primary care physician
Health Screening	Required*	I agree to screen my child/children for fever and/or other health conditions prior to atrium each week.

MEDIA RELEASE

	I/We the parent(s)/guardian(s) of the youth named on this form, authorize and give full consent, without limitations or reservations, to Holy Family Catholic Parish, to publish any photograph or video in which the above-named child/children appear while participating in any program associated with Holy Family Catholic Parsh and its ministries. There will be no compensation for use of any photograph or video at the time of publication or in the future.
I/We agree	Required*
Parent/Guardian	Required*	My typed name constitutes my electronic signature and legal consent. In the event a paper signature is required, I agree to submit the appropriate form.
Parent/Guardian #2

Facebook YouTube Instagram

Faith Formation 2022/23 Registration FAMILY FORM

Catechesis of the Good Shepherd

Online Giving