Christian Formation Online Registration 2021-2022 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 2021-2022 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. Baptism 1st Eucharist Did 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 2021-2022 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. Baptism 1st Eucharist Did 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 2021-2022 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. Baptism 1st Eucharist Did 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*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920