2022-2023 Faith Formation Registration

Emergency Procedure Form
Emergency Contact if unable to reach parents*

First NameLast Name
Emergency Contact Cell Phone*

Area CodePhone Number
Emergency Contact Home Phone

Area CodePhone Number
Emergency Contact Work Phone

Area CodePhone Number
How does the child know this person?*
Please describe any allergies, medical conditions, or other conditions we should be aware of for any or all of your children.
Please include child's name
In the event of a minor injury to your child(ren) while at Faith Formation, we will apply a topical antibiotic and a bandage to the wound, or anti-itch cream to a minor rash, insect bite, etc. If there are any known allergies to this type of medication, please mention it in the above section.
Family Physician

First NameLast Name
Physician's Clinic
Clinic Phone

Area CodePhone Number
Clinic Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family Dentist

First NameLast Name
Dentist Office
Dentist Office Phone

Area CodePhone Number
Dentist Office Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Hospital
Parent/Guardian Signature

Clear

Father/Guardian Information