7045 120th Ave NE, Kirkland WA 98033 |
(425) 822-0295
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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*
-
-
--select--
Home
Mobile
Work
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*
-- select --
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
None--International
Zip*
Parent #2 Name
First Name
Last Name
Relationship to child
Parent #2 Phone
-
-
--select--
Home
Mobile
Work
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*
-
-
--select--
Home
Mobile
Work
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*
Please make a selection
Tuesday August 30th at 7:00 PM
Wednesday September 7th at 10:00 AM
Monday September 26th at 4:00 PM
Thursday October 6th at 6:30 PM
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*
Please make a selection
Yes
No
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*
Please make a selection
Yes
No
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
It may take a moment for your information to be submitted.
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