Family Information Parent(s)/Guardian's Name
Primary Address
Primary Phone Number
Primary Email Address
Mother's Cell Phone Number
Father's Cell Phone Number
Student(s) Live With
Both parents
Mother
Father
Other
Are there any another address/email address you would like information sent to?
School District Student(s) Attend
Emergency/ Medical Contact In the event of an emergency, I give permission to transport my child to a hospital for medical treatment. I wish to be advised prior to any further treatment by a doctor or hospital. In the event of any emergency, and you are unale to reach me at the above numbers, please contact:
Emergency Contact Name/ Phone Number/ Relation to child
Family Health Plan Carrier Number
Family Doctor/Clinic & Phone Number
Student Information Student #1: Name/ Birthdate/ Grade
Where was the Student baptized? (Church, City/State). Students not baptized at St. Joseph Church must provide a copy of their baptismal certificate on the first day of class.
Please list any Health Concerns/ Allergies/ Restrictions:
Student #2: Name/ Birthdate/ Grade
Where was the Student baptized? (Church, City/State). Students not baptized at St. Joseph Church must provide a copy of their baptismal certificate on the first day of class.
Please list any Health Concerns/ Allergies/ Restrictions:
Student #3: Name/ Birthdate/ Grade
Where was the Student baptized? (Church, City/State). Students not baptized at St. Joseph Church must provide a copy of their baptismal certificate on the first day of class.
Please list any Health Concerns/ Allergies/ Restrictions:
Student #4: Name/ Birthdate/ Grade
Where was the Student baptized? (Church, City/State). Students not baptized at St. Joseph Church must provide a copy of their baptismal certificate on the first day of class.
If you need to register more than 4 students, please contact that Faith Formation Coordinator (Cathy Roche) at [email protected]
How Can You Help? We rely on parent volunteers to keep our program active--please check at least one option
*Note: Full tuition covered for all Lead Catechists
Tuition/ Fees Tuition for attending our Wednesday night Faith Formation program is $50 per child with a family cap of $150 for three or more children.
Total Tuition/Fees owed:
Payment Information
I will pay online
I will mail in a check
I would like to arrange a payment plan
Liability & Releases Name/Photo Release: Permission for Student(s) name(s) and/or photo(s) to be used in communication related to Faith Formation to include, but not limited to: newsletters, bulletin, webites, webpages, posters, and bulletin boards.
Name and Photo Release
I give permission for my student(s) Name and/or Photo to be used
I do not give permission for my students(s) name and/or photo to be used.
Liability: I give permission for my child/ren to participate in the Church of St. Joseph Faith Formation and Youth Ministry classes/activities. In consideration of my child's/ren's participation, I agree to indemnify the Church of St. Joseph Church and the Archdiocese of St. Paul & Minneapolis from any claims or law suits brought against the Church of St. Joseph Church/Archdiocese of St. Paul & Minneapolis by myself, my child/ren or others, that arises out of any behavior by my child/ren at Faith Formation/Youth Ministry classes/activities. I also agree to pay reasonable attorney’s fees or expenses incurred by the parish/school and the Archdiocese in defense of such a claim/suit. I the undersigned, have read all the releases and understand all it's terms and execute it voluntarily and with full knowledge of its significance.
Date
Electronic Signature (after signing, you will be directed to a link to make online payment)
