Christian Formation Online Registration Family Name*Primary Family e-mail* Father’s Full Name* First Last Virtus Trained*YesNoMother’s Full Name* First Last Mother’s Maiden Name* Last Virtus Trained*YesNoAddress* Street Address City State ZIP Code Cell Phone*Secondary Phone number*Student InformationStudent’s Name* First Last Full Date of Birth* MM DD YYYY Gender*MaleFemaleGrade for the 2020-2021 school yearSacramental HistoryGive date, church, city and state for each sacrament received.Baptism1st EucharistConfirmationDid this child attend a Catholic Religious Education Program last year?*YesNoIf yes, where?Please select which form of meetings your child will attend*In person onlyVirtual onlyBoth in person and virtualList any allergies, health concerns or special needs that would give our catechists the appropriate support to teach your child:*Release of LiabilityAs parent and/or legal guardian I remain legally responsible for any personal actions taken by the above named minor. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Nicholas Catholic Church, and the Catholic Diocese of Richmond, its employees and agents, chaperons, or representatives associated with St. Nicholas Christian Formation from any claim arising from or in connection with my child attending St. Nicholas youth events or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate St. Nicholas, the Diocese, its employees and agents and chaperons, or representatives associated with the event for reasonable attorney’s fees and expenses which may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the Diocese. I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. In the event of any emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. I will not hold St. Nicholas Catholic Church, and/or the Diocese of Richmond responsible for authorizing any medical treatment beyond necessary transportation to the hospital. Parent / Guardian Signature*Photo ReleaseI give permission for pictures and / or video of my child (named above) engaged in activities related to the Parish or Diocesan events to be posted in St Nicholas Catholic Church publication, websites or other social media.*YesNoParent / Guardian Signature*Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920