2021-2022 Faith Formation & Sacramental Prep Registration Form

PRIMARY CONTACT

Full Name (First, Last) *

Relationship to Child(ren) *

Email *

Phone *

SECONDARY CONTACT

Full Name (First, Last)

Relationship to Child(ren)

Phone

EMERGENCY CONTACT

Full Name (First, Last) *

Phone *

FAMILY'S PRIMARY ADDRESS

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Country

Children live with: *

Both Parents
Father
Mother
Other (Please specify below)

Other

YOUTH INFORMATION

Number of Children Registering

Child #1

First Name *

Last Name *

Gender *

Date of Birth *

Grade 21/22 School Year *

School Attending *

Child #2

First Name *

Last Name *

Gender *

Date of Birth *

Grade 21/22 School Year *

School Attending *

Child #3

First Name *

Last Name *

Gender *

Date of Birth *

Grade 21/22 School Year *

School Attending *

Child #4

First Name *

Last Name *

Gender *

Date of Birth *

Grade 21/22 School Year *

School Attending *

Child #5

First Name *

Last Name *

Gender *

Date of Birth *

Grade 21/22 School Year *

School Attending *

Child #6

First Name *

Last Name *

Gender *

Date of Birth *

Grade 21/22 School Year *

School Attending *

If any of the children you have registered have medical needs, allergies or other needs we should know of please list those here:

If you or any of your children haven’t received one of the Sacraments of Initiation (Baptism, Eucharist or Confirmation), do you seek to receive any of them? *

(In the Diocese of Winona-Rochester 1st Eucharist is celebrated in 2nd grade and Confirmation in 10th grade).

By checking the below box, I, the parent/guardian who will sign below, consent to the DOWR Student Waiver form which I have read entirely online here: (Please copy and paste the following url into a separate browser to view). https://sj.org/wp-content/uploads/2020/08/Student-Waiver-St.-Johns.pdf *

PHOTO/VIDEO DISCLAIMER

I hereby authorize and give full consent, without limitation or reservation, to the Co-Cathedral of St. John the Evangelist, to publish any photograph or video in which my child(ren), named above, appear(s) while participating in any program associated with St. John's. There will be no compensation for use of any photograph or video at the time of publication or in the future.

Date *

Parent Signature *

Signing here sigifnifies that you have read and agreed to the previous two statements regarding the Student Waiver and Photo/Consent Disclaimer.

Checkboxes

K-8th Grade Faith Formation 1 Child - $ 50.00
K-8th Grade Faith Formation 2 Children - $ 80.00
K-8th Grade Faith Formation 3+ Children - $ 110.00
9th Grade Confirmation - $ 50.00
10th Grade Confirmation (includes retreat) - $ 60.00
1st Communion & 1st Reconciliation Prep (In Addition to Faith Formation Cost) - $ 50.00

*** Tuition assistance and payment schedules available upon request – there is no charge to catechists/small group leaders with children in the program

Kindergarten-10thGrade

PRIMARY CONTACT

SECONDARY CONTACT

EMERGENCY CONTACT

FAMILY'S PRIMARY ADDRESS

YOUTH INFORMATION

Child #1

Child #2

Child #3

Child #4

Child #5

Child #6

PHOTO/VIDEO DISCLAIMER

Kindergarten-10^thGrade