Religious Ed Registration Form

Father's Last Name REQUIRED Please fill out this field. Please enter valid data.

Father's First Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number (Using a Catholic Church app called Flocknote, text messages will be a primary source of communication) REQUIRED Please fill out this field. Please enter a phone number.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Mother's Last Name REQUIRED Please fill out this field. Please enter valid data.

Mother's First Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number (Using a Catholic Church app called Flocknote, text messages will be a primary source of communication) REQUIRED Please fill out this field. Please enter a phone number.

Mother's Street Address, if different (Please write "N/A" if not different) REQUIRED Please fill out this field. Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Your Family is currently registered at which Catholic Church? REQUIRED Please fill out this field. Please enter valid data.

Allowed to pick up student other than parent REQUIRED Please fill out this field.
Name 1
- Authorized Pickup Individual(s) REQUIRED
  Enter the name of anyone other than parents authorized to pick up your children from school.
  Please fill out this field. Please enter valid data.
Name 2
- Authorized Pickup Individual(s) REQUIRED
  Enter the name of anyone other than parents authorized to pick up your children from school.
  Please fill out this field. Please enter valid data.
Name 3
- Authorized Pickup Individual(s) REQUIRED
  Enter the name of anyone other than parents authorized to pick up your children from school.
  Please fill out this field. Please enter valid data.
Name 4
- Authorized Pickup Individual(s) REQUIRED
  Enter the name of anyone other than parents authorized to pick up your children from school.
  Please fill out this field. Please enter valid data.

Number of Children registering REQUIRED Please fill out this field.
Student 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 9
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.
Student 10
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Date of Baptism (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of Baptism (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Date of First Communion (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- Place of First Communion (Church, City/State) (If not received N/A) REQUIRED Please fill out this field. Please enter valid data.
- School Attending REQUIRED Please fill out this field. Please enter valid data.
- Grade REQUIRED Please fill out this field. Please enter valid data.
- Special Needs/Learning Disabilities REQUIRED Yes No Please fill out this field.
- Please list any specials needs, dietary restrictions, and any other helpful comments regarding your child/children. Please write "N/A" if none. REQUIRED Please fill out this field.
- Permission to Register for Religious Education is granted by REQUIRED Please fill out this field. Please enter valid data.
- PHOTO RELEASE 2025 - 2026
  
  I hereby grant permission to St. Philip Parish to publish my child's or children's name, photo or video image in connection with a display, feature story or other publications as deemed appropriate by the Parish.
  
  This photo may be used in connection with promotions of parish programs on the webpage, bulletins, Facebook page, and other forms of communications of St. Philip Parish.
- I agree REQUIRED Yes you may use my child's or children's photo No you may not use my child's or children's photo Please fill out this field.
- Permission is granted by: REQUIRED Please fill out this field. Please enter valid data.

MEDICAL TREATMENT RELEASE FORM 2025 - 2026

Reason for which release is intended: St. Philip Roman Catholic Church Religious Education & Events

As a parent/guardian, I do hearby authorize the treatment by a qualified and licensed physician of any condition which, in the opinion of the physician, is deemed necessary and appropriate. This authority is granted only after a reasonable effort has been made to reach me.

Student Name REQUIRED Please fill out this field. Please enter valid data.

Family Physician REQUIRED Please fill out this field. Please enter valid data.

Family Physician Phone Number REQUIRED Please fill out this field. Please enter valid data.

Family Physician Address, City, Zip REQUIRED Please fill out this field. Please enter valid data.

List allergies, medications, contacts, or other pertinent comments REQUIRED Please fill out this field. Please enter valid data.

Health Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Health Insurance Policy/Plan/Member Number REQUIRED Please fill out this field. Please enter valid data.

I further authorize the person who presents the minor to sign the Acknowledgement of Receipt of Notice of Privacy Rights that may be presented by the physician or health care facility.

The authorization is completed and signed of my own free will with the sole purpose of authorizing medical treatment deemed necessary and appropriate by the treating physician.

Permission is granted by REQUIRED Please fill out this field. Please enter valid data.

Today's Date REQUIRED Please fill out this field. Please enter a date.