Fathers Name
First Name
Last Name
Fathers Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Fathers Cell
(###)
###
####
Fathers Email
Fathers Religion
Mothers Name
First Name
Last Name
Mothers Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Mothers Cell
(###)
###
####
Mothers Email
Mothers Religion
First Childs Name
First Name
Last Name
First Childs Gender
Male
Female
First Childs Date of Birth
MM
DD
YYYY
First Childs School Attending
Check if First Childs Received
First Childs Health Concerns, Allergies, Medications or Other Concerns
First Childs Class
8:30am Mass
10:30am Mass
Second Childs Name
First Name
Last Name
Second Childs Gender
Male
Female
Second Childs Date of Birth
MM
DD
YYYY
Second Childs School Attending
Second Childs Check if Received
Second Childs Health Concerns, Allergies, Medications or Other Concerns
Second Childs Class
8:30am Mass
10:30am Mass
Third Childs Name
First Name
Last Name
Third Childs Gender
Male
Female
Third Childs Date of Birth
MM
DD
YYYY
Third Childs School Attending
Third Childs Check if Received
Third Childs Health Concerns, Allergies, Medications or Other Concerns
Third Childs Class
8:30am Mass
10:30am Mass
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone
(###)
###
####
Emergency Contacts Relation to Child
Person with Permission to Pickup Name
First Name
Last Name
Person with Permission to Pickup Phone
(###)
###
####
Person with Permission to Pickup Relation to Child
Children will only be released to parents, legal guardians, emergency contact, or persons authorized by parent or legal guardian.
*
I give my permission for my child(ren) (named above) to participate in Saint Raphael the Archangel Catholic Church Atrium. I understand that children will be well supervised, and I will not hold Saint Raphael the Archangel Catholic Church, its employees or volunteers responsible if an accident should occur.
*
I give my permission for photos of my family, taken at parish events, including CGS atrium, to be used in parish publications, including newsletters, bulletin, social media, and the website. Names will not be posted.
