Faith Formation Registration Family Last Name Child's Last Name (if different) Primary Phone Number Home Address Father Father's Full Name Father's Cell/Work Number Father's E-mail Mother Mother's Full Name Mother's Cell/Work Number Mother's E-mail Custodial Parent/Guardian, if different from above Full Name Cell/Work Number E-mail Are you a registered member of St. Bernard Parish? YesNo If no, where? What is the best number to reach you at during business hours? Consent Picture Consent: Do we have your permission to take your child/children’s picture during the year for display in the hallway, bulletin, screen/website, etc. of different activities that they are involved in?YesNo Protecting God’s Children Consent: The Diocese of Green Bay mandates that all parishes hold the equivalent of one class for each grade level, each year, regarding Safe Environment and Protecting God’s Children from harm. Do you give permission for your child to be a part of this class? YesNo First Child Child’s Name Date of Birth Grade Entering in Fall School Attending Faith Formation Class 4:40 (K-6)6:30 (1-10) BaptismYesNo Parish of Baptism if not St. Bernard (include State) First Reconcil-iationYesNo First EucharistYesNo Special Needs – Including medical, learning & physical challenges Second Child Child’s Name Date of Birth Grade Entering in Fall School Attending Faith Formation Class 4:40 (K-6)6:30 (1-10) BaptismYesNo Parish of Baptism if not St. Bernard (include State) First Reconcil-iationYesNo First EucharistYesNo Special Needs – Including medical, learning & physical challenges Third Child Child’s Name Date of Birth Grade Entering in Fall School Attending Faith Formation Class 4:40 (K-6)6:30 (1-10) BaptismYesNo Parish of Baptism if not St. Bernard (include State) First Reconcil-iationYesNo First EucharistYesNo Special Needs – Including medical, learning & physical challenges Fourth Child Child’s Name Date of Birth Grade Entering in Fall School Attending Faith Formation Class 4:40 (K-6)6:30 (1-10) BaptismYesNo Parish of Baptism if not St. Bernard (include State) First Reconcil-iationYesNo First EucharistYesNo Special Needs – Including medical, learning & physical challenges