Faith Development 2020-2021 Registration

Family 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.

Guardian 1 First Name REQUIRED Please fill out this field. Please enter valid data.

Guardian 1 Email REQUIRED Please fill out this field. Please enter an email address.

Guardian 1 Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Guardian 1 Religion REQUIRED Please fill out this field. Please enter valid data.

Relationship to Child REQUIRED Please fill out this field. Please enter valid data.

Guardian 2 First Name Please enter valid data.

Guardian 2 Email Please enter an email address.

Guardian 2 Phone Number Please enter a phone number.

Guardian 2 Religion Please enter valid data.

Relationship to Child Please enter valid data.

Custody Concerns* REQUIRED Yes No Please fill out this field.

* If yes, the parent or guardian must provide a signed, dated letter of permission to the Faith Development Office, which is kept on file and must be updated annually. If there are custody/legal issues, please provide a complete copy of the latest court order.

Legal Guardian Photography Notice: by checking the box below, you are agreeing to the following statement,

I give permission for my child/guardianship to be photographed and/or videotaped and understand that these photographs and/or videos may be used in publications, websites or other materials produced by Holy Infant Church or the Diocese of Raleigh. Participants will not be identified without specific written consent.

I Agree Please select this field.

Consent for Medical Care: by checking the box below, you are agreeing to the following statement,

I give permission that, in my absence, the children whose names I have entered into this form may receive emergency medical care for injuries and all situations that may occur while participating in the Faith Development Programs and activites at or run by Holy Infant Church.

I Agree Please select this field.

Child Information

First Name REQUIRED Please fill out this field. Please enter valid data.
Last Name (if different than above) Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Sex REQUIRED Please fill out this field.
Sacraments celebrated by 7/24/2020 REQUIRED Baptism Eucharist Confirmation Please fill out this field.
Name of Day School REQUIRED Please fill out this field. Please enter valid data.
Rising Grade Level REQUIRED Please fill out this field.
Disability - As defined by Individuals with Disabilities Education Act (IDEA), the term "child with a disability" means a child: "with intellectual disabilities, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, austism, traumatic brain injury, other health impairments, or specific learning disabilities; and who, by reason thereof, needs special education and related services."
Does your child have an Individualized Education Plan (IEP)? REQUIRED Yes No Please fill out this field.
If yes, please elaborate including diagnosis, learning support services in place, and/or any pertinent medications Please enter valid data.
Any additional documented disabilities, medical conditions or allergies? Please enter valid data.

Any additional information about your family or child(ren) that you would like to share? Please enter valid data.

Registration Fee REQUIRED Family with 1 Child ($120) Family with 2 Children ($170) Family with 3 or more Children ($220) Please fill out this field.

K-6: After watching the introduction video above, what is your community group formation preference? Monthly In-Person Gatherings Monthly Virtual Gatherings

JYM/TYM: After watching the introduction video above, how will you be joining youth ministry this year? In-Person Gatherings Virtual Gatherings

To authorize above, please check "yes" and type your full name into the box labeled "authorizing party." This will count as your legal signature. REQUIRED Yes Please fill out this field.

Full Name of Authorizing Party REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter a date.

Faith Development 2020-2021 Registration

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