Religious Education Registration Form PARENTS INFORMATION Last Name: Parish Registration: YesNo Parish ID #: Address: Street: City: State: Zip Code: Home Phone: Email(Class assignments and ALL important notifications will be emailed to this address) Mother’s Name & (Maiden Name): Cell #: Father’s Name: Cell #: Emergency Contact (during class time other than a parent) Name: Relationship to Child: Home Phone: CHILD INFORMATION (One Form per child) Child Place of Birth: Date of Birth: Grade in School: Does he attend a Catholic School: YesNo Place of baptism: Date of baptism: Please Check Sacraments my child has received: BaptismConfirmation1st Communion Reconciliation Is The Child planning to receive his/her First Communion this year? (Please Check) YesNo If Child is planning to receive his/her First Communion a Copy of his/her Baptismal certificate if it’s not in the church baptismal register must be submitted Learning challenges, social concerns, medications, allergies or other information: Registration Fees Kindergarten: $15 /CHILD 1st-3rd Grades: $15 /CHILD 4th-5th Grade: $15/CHILD/1st Communion $25 /CHILD (To cover the expenses of the materials. Books are sold separate) PAYMENTS: Cash & Checks are accepted. Checks must be made to: St Anthony Maronite Church Check #: Cash Amount: IMPORTANT INFORMATION: In an emergency, and if a parent cannot be contacted, you have my permission to contact the following person to help make decisions regarding the care for my child: Name: Relationship: Home Phone #: Cell Phone #: I hereby consent and authorize Father Elie Mikhael or his designated representative, to obtain and provide for my son/daughter any and all medical care or treatment which might become necessary, until either parent or the emergency contact person can be reached. I further expressly release and waive Father Elie Mikhael, his designated representative, and St. Anthony Maronite Church, and the Eparchy of St. Maron of Brooklyn, from any liability, action, claim, cause of action which I might otherwise have in the event of illness or injury during the period that my son/daughter is attending the Sunday School. Parent Signature: Date: PHOTO RELEASE (Please check appropriate box below) 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 another printed media. I / We consentdo not consent (check one) to the use of such materials in which I may appear. I release the staff and volunteers of St. Sharbel Mission and the Eparchy of St Maron of Brooklyn, NY from any liability connected with the use of my child’s picture or voice recording as part of any of the above or similar activities. Parent Signature: Date: