2020-2021 Religious Formation Registration/Registro

Date/Fecha REQUIRED Please fill out this field. Please enter valid data.

Family Last Name/Apellido de la familia REQUIRED Please fill out this field. Please enter valid data.

Phone # (Primary/Primario) REQUIRED Please fill out this field. Please enter valid data.

Address/Direccion REQUIRED Please fill out this field. Please enter valid data.

City/Ciudad REQUIRED Please fill out this field. Please enter valid data.

Zip/Codigo Postal REQUIRED Please fill out this field. Please enter valid data.

Email(s)/Correo(s) Electronico REQUIRED Please fill out this field. Please enter valid data.

Father/Padre/Guardian (Last name, First name / apellido paterno, primer nombre) REQUIRED Please fill out this field. Please enter valid data.

Cell Phone and Work Phone / Cellular and Trabajo REQUIRED Please fill out this field. Please enter valid data.

Mother/Madre/Guardian (Last name, First name, Maiden Name) (apellido de casada, primer nombre, apellido de soltera) REQUIRED Please fill out this field. Please enter valid data.

Cell Phone and Work Phone / Cellular and Trabajo REQUIRED Please fill out this field. Please enter valid data.

STUDENT #1 INFORMATION / INFORMACION DE ESTUDIANTE #1

Family Name/Apellido Paterno REQUIRED Please fill out this field. Please enter valid data.
First Name/Nombre REQUIRED Please fill out this field. Please enter valid data.
Middle Name/Segundo Nombre Please enter valid data.
Gender/Genero REQUIRED Please fill out this field.
Birthdate/ Fecha de nacimiento REQUIRED Please fill out this field. Please enter a date.
Grade for Fall of 2020/Grado que cursa REQUIRED Please fill out this field.
Sacraments Received/Sacramentos recibido? Baptism/Bautizo Reconciliation First Communion/primera comunión Confirmation
Session preference / Sesión preferencia REQUIRED Please fill out this field.
Session Language (EN/SP) REQUIRED Please fill out this field.
Session Day/Dia de Sesión REQUIRED Please fill out this field.

STUDENT #2 INFORMATION / INFORMACION DE ESTUDIANTE #2

Family Name/Apellido Paterno Please enter valid data.
First Name/Nombre Please enter valid data.
Middle Name/Segundo Nombre Please enter valid data.
Gender/Genero
Male
Birthdate/ Fecha de nacimiento Please enter a date.
Grade for Fall of 2020/Grado que cursa
Sacraments Received/Sacramentos recibido? Baptism/Bautizo Reconciliation First Communion/primera comunión Confirmation
Session preference / Sesión preferencia
Session Language (EN/SP)
Session Day/Dia de Sesión

STUDENT #3 INFORMATION / INFORMACION DE ESTUDIANTE #3

Family Name/Apellido Paterno Please enter valid data.
First Name/Nombre Please enter valid data.
Middle Name/Segundo Nombre Please enter valid data.
Gender/Genero
Male
Birthdate/ Fecha de nacimiento Please enter a date.
Grade for Fall of 2020/Grado que cursa
Sacraments Received/Sacramentos recibido? Baptism/Bautizo Reconciliation First Communion/primera comunión Confirmation
Session preference / Sesión preferencia
Session Language (EN/SP)
Session Day/Dia de Sesión

STUDENT #4 INFORMATION / INFORMACION DE ESTUDIANTE #4

Family Name/Apellido Paterno Please enter valid data.
First Name/Nombre Please enter valid data.
Middle Name/Segundo Nombre Please enter valid data.
Gender/Genero
Birthdate/ Fecha de nacimiento Please enter a date.
Grade for Fall of 2020/Grado que cursa
Sacraments Received/Sacramentos recibido? Baptism/Bautizo Reconciliation First Communion/primera comunión Confirmation
Session preference / Sesión preferencia
Session Language (EN/SP)
Session Day/Dia de Sesión
PARENT FAITH COMMITMENT TO CHURCH AND FOLLOW THE GUIDELINES/COMPROMISO DE FE A LA IGLESIA Y SEGUIR LOS LINEAMIENTOS
Signature/Firma and Relationship/Relación REQUIRED Please fill out this field. Please enter valid data.
Agreed / De acuerdo REQUIRED Please fill out this field.

MEDICAL RELEASE/EMERGENCY INFORMATION/FORMULARIO MEDICO

Family Doctor / doctora de familia REQUIRED Please fill out this field. Please enter valid data.
Doctor's phone number/Número de teléfono REQUIRED Please fill out this field. Please enter valid data.
Health Insurance Company REQUIRED Please fill out this field. Please enter valid data.
Health Insurance Policy Number REQUIRED Please fill out this field. Please enter valid data.
Health Insurance Group Number REQUIRED Please fill out this field. Please enter valid data.
Name of Emergency Contact(s)/Nombre del contacto(s) de emergencia REQUIRED Please fill out this field. Please enter valid data.
Relationship of Emergency Contact(s)/relación de contacto(s) de emergencia REQUIRED Please fill out this field. Please enter valid data.
Phone Number of Emergency Contact(s) (cell, work, home)/Número de teléfono del contacto de emergencia (celular, trabajo, hogar) REQUIRED Please fill out this field. Please enter valid data.
List STUDENT NAME, MEDICAL DIAGNOSIS/BEHAVIORAL CONDITIONS, MEDICATIONS TAKEN for any allergies, medical problems, behavioral issues, or other pertinent information. (e.g. Diabetes, Asthma, ADD, ADHD, Autism, Dyslexia, Seizure Disorder, Allergies, etc.) Please enter valid data.
Parent or Guardian Authorization/Autorización del Padre or Tutor
Parent or Guardian Authorization - enter in name for consent / Autorización del Padre or Tutor-ingrese el nombre para el consentimiento REQUIRED Please fill out this field. Please enter valid data.