Faith Formation Registration Form

- Faith Formation

registration information
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- Welcome to another year of Faith Formation at St. Mary! Please enter your family information. For additional children or if your child has any special needs, please enter the information in the Additional Information box at the bottom of the form.
  Complete schedule and handbook coming soon.
  
  Registration is $75/family. Please notify Jean Dorothy if this is a financial burden for you, smpreschool@lisco.com or 641-472-3179.
- Parent/Guardian Information
- Family Last Name REQUIRED Please fill out this field. Please enter valid data.
- 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.
- Father's First Name REQUIRED Please fill out this field. Please enter valid data.
- Father's Religion Please enter valid data.
- Mother's First Name REQUIRED Please fill out this field. Please enter valid data.
- Mother's Religion Please enter valid data.
- Children live with... REQUIRED Please fill out this field.
- Name of guardian if different than listed above Please enter valid data.
- Home Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Father's Cell Phone Maximum 20 characters Please enter a phone number.
- Father's Email Please enter an email address.
- Mother's Cell Phone Please enter an email address.
- Mother's Email Address Please enter an email address.
- Child(ren) Information
- Child 1 Name REQUIRED Please fill out this field. Please enter valid data.
- Age REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Grade in School REQUIRED Please fill out this field. Please enter valid data.
- Please choose from the following options.
- Baptism REQUIRED Please fill out this field.
- First Communion REQUIRED Please fill out this field.
- Confirmation REQUIRED Please fill out this field.
- Child 2 Name Please enter valid data.
- Age Please enter valid data.
- Date of Birth Please enter valid data.
- Grade in School Please enter valid data.
- Please choose from the following options.
- Baptism
- First Communion
- Confirmation
- Child 3 Name Please enter valid data.
- Age Please enter valid data.
- Date of Birth Please enter valid data.
- Grade in School Please enter valid data.
- Please choose from the following options.
- Baptism
- First Communion
- Confirmation
- Child 4 Name Please enter valid data.
- Age Please enter valid data.
- Date of Birth Please enter valid data.
- Grade in School Please enter valid data.
- Please choose from the following options.
- Baptism
- First Communion
- Confirmation
- Additional Information
- I understand that reasonable precautions will be taken to safeguard the health and well-being of the participants in the St. Mary Faith Formation Programs and that I will be notified as soon as possible in the event of an emergency. In the case of sickness or an accident, I authorize and consent the Faith Formation Team, or other associated volunteers of the Faith Formation Program to obtain medical care from a licensed physician, hospital or medical clinic for my son/daughter in the event that myself or other legal guardian(s) cannot be reached. I hereby do release and forever discharge the Diocese, and Parish from all manners of actions, claims which I or the child named above shall or may have for any reason, arising during my child's attendance of the Faith Formation Programs.
  
  Unless other written instruction is submitted, I also consent to allowing my child's image to be recorded, either by photograph or video, and used for future advertisement of Faith Formation Programs. Any other use will require further consent.
- I Agree Please select this field.
Submit

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St. Mary Catholic Church

"A welcoming family of faith"

Faith Formation Registration Form

registration information

Parent/Guardian Information

Child(ren) Information