Registration Form

Mothers Full Name

Mothers Phone Number

Fathers Full Name

Fathers Phone Number

Home Address

Best Email Address

Number of Children Attending KOM

Full Name of Child 1

Child 1 Grade
KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6

Full Name of Child 2

Child 2 Grade
KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6

Full Name of Child 3

Child 3 Grade
KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6

Full Name of Child 4

Child 4 Grade
KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6

Is/are the child/children attending Public of Private school?
PubicPrivate

"Is your child ( grade 1 to grade 6) interested in joining the children's choir?"
YesNo

Please Note: Choir practices will be held separately from the Knights of Mary program hours. The schedule will be determined at a later date.

Please list any Medical Concerns* (including developmental delays, allergies or other conditions that would help the teachers provide appropriate care and support)

Emergency Contact
Persons Name

Relationship to the Child

Phone Number

Volunteer opportunity
- For Mothers/Parents Interested in Volunteering:

If you have the time, resources, and would like to assist us as an advisor in our program, we would love to have your support!
Please feel free to reach out to Gretta Merheb for more information at:
E-mail: [email protected]
Phone: 617-669-1699

AUDIO VISUAL TAPING AND PHOTOGRAPHY CONSENT:
On occasion, videotape, audio tape, slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements, and other printed media.

IWe consentdo not consent

Parent Signature to sign for commitment