Faith Formation Registration

Faith Formation Registration

Returning Students 2019-2020
A COPY OF COMPLETED SACRAMENT CERTIFICATES MUST BE ON FILE WITH THE FAITH FORMATION OFFICE

Please fill out the information for each child | select which Sacraments have been at PBVM*

	Child Full Name (Last, Middle, First)	M/F	Grade	Attended Last Year?	Birth Date	Baptism	Holy Communion	Confirmation
Child #1
Child #2
Child #3
Child #4

So that we can best serve your child, please list any known conditions that we should be made aware of:*
I.E. Learning Disabilities, Allergies, Medications, Medical, Physical, Emotional, Behavioral, etc.
Primary Doctor's Name:

First NameLast Name
Phone Number

Area CodePhone Number
Insurance Company:
Card and/or Group #
Address:

Street Address

Street Address Line 2

CityState

Zip Code
By signing below, I request the above-named participant be allowed to attend church realted activites with Presentation of the Blessed Virgin Mary Catholic Church. I, the parent/guardian of the above named student do hereby give permission for him/her to attend Faith Formation/Sacramental Preparation classes and to be treated for a medical emergency in my absence while participating in the Faith Formation program. The adult supervisor may act as an agent in my absence.
Name Signing:

First NameLast Name
Date*

MonthDayYear
Date
Signature of Parent/Guardian
Registration Fee's: Please select the number of children you are registering and the number of sacraments that they will be receiving this year (2nd Graders & 8th Graders
prevnext( X )
Children to Register$85.00

Number of Children

Sacrament Fee's$30.00

Sacrament Fee

Total $0.00
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