2024 Faith Formation Registration – Indiana Region - Roman Catholic Diocese of Greensburg

2024 Faith Formation Registration – Indiana Region

"*" indicates required fields

If your child or you would like to participate in Faith Formation, please complete, sign, and submit the following statement of consent and release of liability. As parent or legal guardian, you remain fully responsible for any legal responsibility which may result from any personal actions taken by the named minor or by yourself as the attendee.

Select the parish/program your child(ren) will be registering with for Faith Formation*

Liability and Release, Photographic Release, Permission Form, and Waiver Authorization

Signature of Parent/Guardian*

General Information

Family Last Name*

Family Mailing Address*

Street Address Address Line 2 City State ZIP Code

Parent Cell Phone*

Parent Email*

Church*

If other, please list church where you worship (if applicable)

Emergency Contact Information

Emergency Contact 1*

First Last

Cell Phone*

Home Phone*

Emergency Contact 2 – Other than Parent*

First Last

Cell Phone*

Home Phone*

Insurance Information

Insurance Company*

Policy Number*

Group Number

Participants

Participant #1 Name*

First Last

Participant #1 Date of Birth*

Participant #1 Age*

Please enter a number from 3 to 99.

Participant #1 School District*

2024-2025 Grade*

Pre-K students must be potty trained. All grades are based upon the 2024-2025 school year.

Gender*

Does first participant have any health conditions, diagnoses, or allergies that we should be aware of that might affect participation in Formation?*

Please list any physical or mental health conditions that might affect the child’s participation in small groups, large groups, or various activities. Any information you provide will help us to best provide for your child.

If yes, please explain

Do you need to register a second participant?*

Participant #2 Name*

First Last

Participant #2 Date of Birth*

Participant #2 Age*

Please enter a number from 3 to 99.

Participant #2 School District*

2024-2025 Grade*

Pre-K students must be potty trained. All grades are based upon the 2024-2025 school year.

Gender*

Does second participant have any health conditions, diagnoses, or allergies that we should be aware of that might affect participation in Formation?*

If yes, please explain

Do you need to register a third participant?*

Participant #3 Name*

First Last

Participant #3 Date of Birth*

Participant #3 Age*

Please enter a number from 3 to 99.

Participant #3 School District*

2024-2025 Grade*

Pre-K students must be potty trained. All grades are based upon the 2024-2025 school year.

Gender*

Does third participant have any health conditions, diagnoses, or allergies that we should be aware of that might affect participation in Formation?*

If yes, please explain

Do you need to register a fourth participant?*

Participant #4 Name*

First Last

Participant #4 Date of Birth*

Participant #4 Age*

Please enter a number from 3 to 99.

Participant #4 School District*

2024-2025 Grade*

Pre-K students must be potty trained. All grades are based upon the 2024-2025 school year.

Gender*

Does fourth participant have any health conditions, diagnoses, or allergies that we should be aware of that might affect participation in Formation?*

If yes, please explain

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2024 Faith Formation Registration – Indiana Region