Faith Formation Registration Form

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Family Last Name REQUIRED Please fill out this field. Please enter valid data.
Date REQUIRED
Enter today's date
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Email REQUIRED
This is used for communication for events and activities, as well as submission and payment confirmation.
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Mailing 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.
Parent Information
- Father's Name Please enter valid data.
- Father's Phone # Maximum 20 characters Please enter a phone number.
- Mother's Name Please enter valid data.
- Mother's Phone # Maximum 20 characters Please enter a phone number.
- I/We could also assist as a . . .
  Please check any where you are able to assist
  Teacher Aide Parent Leader Other (indicate below)
- Other assistance (please specify)
  If you are able to assist in some other way, please share.
  Please enter valid data.
Living Grandparent Information
- Paternal Grandparents' Name(s) and Location Please enter valid data.
- Street Address
  Paternal grandparents' street address
  Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Maternal Grandparents' Name(s) and Location Please enter valid data.
- Street Address
  Maternal grandparents' street address
  Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Great-grandparents' Names and Locations
  Please list names and locations of any great-grandparents that are still living.
Student Information
- Number of Children REQUIRED Please fill out this field.
- Child 1
  - Child's Name REQUIRED Please fill out this field. Please enter valid data.
  - School Please enter valid data.
  - Grade
  - This child is interested in participating in choir REQUIRED Yes No Please fill out this field.
  - Sacrements Received
    Please check all that apply
    Baptism 1st Comm. Penance Confirmation
  - Please list any allergies or medical conditions of which the staff should be aware.
  - Allergies / Other Awareness
  - Release of liability
    
    I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
    
    I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
    I Agree and Confirm My Understanding Please select this field.
- Child 2
  - Child's Name REQUIRED Please fill out this field. Please enter valid data.
  - School Please enter valid data.
  - Grade
  - This child is interested in participating in choir REQUIRED Yes No Please fill out this field.
  - Sacrements Received
    Please check all that apply
    Baptism 1st Comm. Penance Confirmation
  - Please list any allergies or medical conditions of which the staff should be aware.
  - Allergies / Other Awareness
  - Release of liability
    
    I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
    
    I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
    I Agree and Confirm My Understanding Please select this field.
- Child 3
  - Child's Name REQUIRED Please fill out this field. Please enter valid data.
  - School Please enter valid data.
  - Grade
  - This child is interested in participating in choir REQUIRED Yes No Please fill out this field.
  - Sacrements Received
    Please check all that apply
    Baptism 1st Comm. Penance Confirmation
  - Please list any allergies or medical conditions of which the staff should be aware.
  - Allergies / Other Awareness
  - Release of liability
    
    I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
    
    I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
    I Agree and Confirm My Understanding Please select this field.
- Child 4
  - Child's Name REQUIRED Please fill out this field. Please enter valid data.
  - School Please enter valid data.
  - Grade
  - This child is interested in participating in choir REQUIRED Yes No Please fill out this field.
  - Sacrements Received
    Please check all that apply
    Baptism 1st Comm. Penance Confirmation
  - Please list any allergies or medical conditions of which the staff should be aware.
  - Allergies / Other Awareness
  - Release of liability
    
    I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
    
    I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
    I Agree and Confirm My Understanding Please select this field.
- Child 5
  - Child's Name REQUIRED Please fill out this field. Please enter valid data.
  - School Please enter valid data.
  - Grade
  - This child is interested in participating in choir REQUIRED Yes No Please fill out this field.
  - Sacrements Received
    Please check all that apply
    Baptism 1st Comm. Penance Confirmation
  - Please list any allergies or medical conditions of which the staff should be aware.
  - Allergies / Other Awareness
  - Release of liability
    
    I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
    
    I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
    I Agree and Confirm My Understanding Please select this field.
- Child 6
  - Child's Name REQUIRED Please fill out this field. Please enter valid data.
  - School Please enter valid data.
  - Grade
  - This child is interested in participating in choir REQUIRED Yes No Please fill out this field.
  - Sacrements Received
    Please check all that apply
    Baptism 1st Comm. Penance Confirmation
  - Please list any allergies or medical conditions of which the staff should be aware.
  - Allergies / Other Awareness
  - Release of liability
    
    I hereby grant permission for this child to be transported to an emergency medical or healthcare facility for immediate treatment and/or consultation if deemed necessary. I understand that this child's emergency contact will be notified of any emergency situation immediately. I agree to be financially responsible for any and all medical expenses and/or treatment costs, and I release the Church of the Resurrection and all associated volunteers or staff from any liability.
    
    I understand that this event is not sponsored by the Diocese of Grand Island. I accept full responsibility for any legal or financial consequences, i.e., damage to property or other participants/staff, that may result from any personal actions taken by me or this child, and I agree to hold the Church of the Resurrection and all associated volunteers or staff harmless with respect to any actions or claims that may be made in connection with personal actions taken by me or this child. I also grant permission to the Church of the Resurrection to use this child's photo and video for publicity/marketing purposes.
    I Agree and Confirm My Understanding Please select this field.
Tuition Cost REQUIRED
Please select the appropriate option for tuition
40.0 – One Child 80.0 – Two Children 90.0 – Family Rate Please fill out this field.

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Resurrection Catholic Church

Grand Island, NE

Faith Formation Class Registration Form