K-5 Christian Formation Online Registration 2022-2023 Family Name*Primary Family e-mail* Father’s Full Name* First Last Virtus Trained* Yes No Mother’s Full Name* First Last Virtus Trained* Yes No Address* Street Address City State ZIP Code Cell Phone*Secondary Phone number*Student Information #1Student’s Name* First Last Full Date of Birth* Month Day Year Gender* Male Female Grade entering the 2022-2023 school year*Sacrament HistoryGive date, church, city and state for each sacrament received. If Sacrament is needed, write "Need". * For parents of second grader, a copy of your child's baptism certificate will be needed. Baptism1st EucharistDid this child attend a Catholic Religious Education Program last year?* Yes No If yes, where?List any allergies, health concerns or special needs that would give our catechists the appropriate support to teach your child:*Student Information #2Student’s Name First Last Full Date of Birth Month Day Year Gender Male Female Grade entering the 2022-2023 school yearSacrament HistoryGive date, church, city and state for each sacrament received. If Sacrament is needed, write "Need". * For parents of second grader, a copy of your child's baptism certificate will be needed. Baptism1st EucharistDid this child attend a Catholic Religious Education Program last year? Yes No If yes, where?List any allergies, health concerns or special needs that would give our catechists the appropriate support to teach your child:Student Information #3Student’s Name First Last Full Date of Birth Month Day Year Gender Male Female Grade entering the 2022-2023 school yearSacrament HistoryGive date, church, city and state for each sacrament received. If Sacrament is needed, write "Need". * For parents of second grader, a copy of your child's baptism certificate will be needed. Baptism1st EucharistDid this child attend a Catholic Religious Education Program last year? Yes No If yes, where?List any allergies, health concerns or special needs that would give our catechists the appropriate support to teach your child:Release of LiabilityI, [Parent/Guardian named above] grant permission for my child(ren) [named above] to participate in any Saint Nicholas Catholic Church sponsored event(s) for which they are registered throughout the year. I understand that these events will take place under the guidance and direction of parish employees and/or volunteers from the parish [named above]. In the event of any emergency, I give authority to the accompanying adults to authorize treatment. I understand that an attempt to notify me will be made before any treatment is authorized. As parent/legal guardian, I remain legally responsible for any personal action taken by my child. 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.* Yes No Parent / Guardian Signature*Date*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920