FF Registration 2022-23 – St. Mary's Catholic Church

Parents Name*

First Last

Students Name*

First Last Grade

Students Name

First Last Grade

Students Name

First Last Grade

Students Name

First Last Grade

Students Name

First Last Grade

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Contact Email*

Primary Contact Phone*

Primary Contact's Preferred method of Contact

Email
Text Message

Secondary Contact Name

First Last

Secondary Contact Email

Secondary Contact Phone

Emergency Contact, not listed above.*

First Last

Dietary Restrictions / Allergies (please include students name)

Emergency Contact Phone*

Consent

I authorize any representative of St. Mary's Church as my agent to consent to any emergency examination, x-ray, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is rendered under the supervision of a licensed physician or surgeon. I am aware that all attempts will be made to contact me first in case of an emergency and that this is ONLY if I or my emergency contact cannot be reached.

Consent

I hereby consent to the use and release of any photograph that my child is in for promotional materials or news stories in St. Mary's Parish and the Diocese of Davenport. I understand that these photographs may be posted on the parish or diocesan websites as well.

My family's preferred language

English
Spanish

My family has access to online materials.

Yes
No

My family is able to print activities and resources.

Yes
No

I would like more information on sacrament preparation.

I have a child(ren) grade 7th or older wanting to prepare for Confirmation.
I have a child(ren) grade 2nd or older wanting to prepare for Fist Sacraments.

My preference for Middle School Youth group is...

Wednesday night at 6:15 P.M.
Sunday night at 6:15 P.M.

I have a high schooler interested in...

Sunday morning Bible Study
Wednesday afternoon Discipleship Group

2022-23 Family Formation Registration