Off Campus Permission Form High School Faith Formation Registration Family Name(Required) Last Address Street Address City, State ZIP Code Mother's Name First Last (if different) Father's Name First Last Mother's PhoneFather's PhoneMother's Email Father's Email Emergency Contact(Required) First Last Emergency Phone(Required)Student informationStudent's Name(Required) First Last Birthdate(Required) Month Day Year AgePlease enter a number from 0 to 18.Gender Grade School T-shirt size Allergies or Special Needs?(Required) Yes No Allergies/Special Needs Details Name First Last Birthdate Month Day Year AgePlease enter a number from 0 to 18.Gender Grade School T-shirt size Allergies or Special Needs? Yes No Allergies/Special Needs Details Name First Last Birthdate Month Day Year AgePlease enter a number from 0 to 18.Gender Grade School T-shirt size Allergies or Special Needs? Yes No Allergies/Special Needs Details Name First Last Birthdate Month Day Year AgePlease enter a number from 0 to 18.Gender Grade School T-shirt size Allergies or Special Needs? Yes No Allergies/Special Needs Details ConsentMedical Release(Required) I agree to the medical policy. I certify that I am the custodial parent/legal guardian of the minor children listed above. In the event of sickness or medical emergency where I am not present and cannot be reached, I request that my child(ren) receive any medical attention or treatment deemed necessary by the Staff or Volunteer leaders of St. Patrick - St. Anthony Parish. The above-named child(ren) has my permission to travel for medical treatment in a privately-owned vehicle or ambulance. In addition, I do hereby authorize treatment by a qualified and license Medical Doctor in an emergency which, in the opinion of the attending physician, may endanger the child’s life, cause disfigurement, physical impairment, or undue discomfort if delayed. Parent/Legal Guardian First Last Date Month Day Year Consent to Direct Contact (5th-12th Grade Only)(Required) I agree to direct contact.I (Parent/Legal Guardian) give consent for the youth minister, Makenzie Conner, to contact my children listed below between the ages of 7th-12th grade. Via text message, calling, and email at the below information.Student PhoneStudent Email Student PhoneStudent Email Parent/Legal Guardian First Last Date Month Day Year Photo Release I agree to the photography policy.I understand that through their participation in this program, my child(ren) listed on this registration may be photographed for use in the promotion of parish & diocesan programs. As parent/guardian, I give permission for my child(ren) to be photographed during this program.Parent/Legal Guardian First Last Date Month Day Year 2022-23 Registration Fees$40.00 for one child, $75.00 for two or rmore Maximum is $75.00 per family If possible, payment is expected at the time of registration. If financial help is needed, please contact Tony Allen at 616-935-8737.Registration for One Student Price: Registration for Two Students (or More) Price: EmailThis field is for validation purposes and should be left unchanged. Faith Formation Payment Link
