Fathers Name

First Name

Last Name

I am interested in being involved in the Atrium

Yes

No

Fathers Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Fathers Cell

(###)

###

####

Mothers Name

First Name

Last Name

I am interested in being involved in the Atrium

Yes

No

Mothers Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Mothers Cell

(###)

###

####

First Childs Name

First Name

Last Name

First Childs Date of Birth

MM

DD

YYYY

This is my child's first year in the Atrium

Yes

No

Check if First Childs Received

Baptism

Penance

Eucharist

Confirmation

Second Childs Name

First Name

Last Name

Second Childs Date of Birth

MM

DD

YYYY

This is my child's first year in the Atrium

Yes

No

Second Childs Check if Received

Baptism

Penance

Eucharist

Confirmation

Third Childs Name

First Name

Last Name

Third Childs Date of Birth

MM

DD

YYYY

This is my child's first year in the Atrium

Yes

No

Third Childs Check if Received

Baptism

Penance

Eucharist

Confirmation

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Person with Permission to Pickup Name

First Name

Last Name

Person with Permission to Pickup Phone

(###)

###

####

Children will only be released to parents, legal guardians, emergency contact, or persons authorized by parent or legal guardian. *

I understand

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 permission and understand

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.

I give my permission