Faith Formation Registration

Family Name Please enter valid data.

Parent/ Guardian 1

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

Last 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.

Occupation Please enter valid data.

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

Preferred Email for Correspondence REQUIRED Please fill out this field. Please enter an email address.

Are you a registered parishioner of St. Clare's? REQUIRED Please fill out this field.

Parent/ Guardian 2

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

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Occupation Please enter valid data.

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

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

Are you a registered parishioner of St. Clare's?

Number of Children to be Registered REQUIRED Please fill out this field.
Child 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies
Child 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies
Child 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies
Child 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies
Child 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies
Child 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies
Child 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies
Child 8
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Sex REQUIRED Please fill out this field.
- Grade Level in Fall 2021 REQUIRED Please fill out this field.
- Please select which Sacraments your child has ALREADY received REQUIRED Baptism ( Non- Catholic ) Baptism First Reconciliation First Eucharist Confirmation None Please fill out this field.
- Which program would you like to register this child for? REQUIRED Please fill out this field.
- Are there any accommodations we need to be aware of (medical, cognitive, developmental, emotional, physical) that will impact your child's ability to learn or participate in activities? If not, please write "None" in the box below.
- Special Accommodations, Support, Health Concerns, or Allergies

* If any of the following medical information and/or waivers and consent vary by child, please indicate this in the "Additional Notes" at the end of this registration form. Otherwise the medical information, waivers, and consent indicated below will apply to all children registered on this form.

Family Medical Information

Family Doctor's Name Please enter valid data.

Doctor's Phone Number Please enter a phone number.

Insurance Name Please enter valid data.

Insurance Group Number Please enter valid data.

Insurance Phone Number Please enter a phone number.

Emergency Medical Contact if Parent Cannot Be Reached

First Name Please enter valid data.

Last Name Please enter valid data.

Phone Number Please enter a phone number.

Relationship to the Child(ren) Please enter valid data.

Medical Consent/Liability Waiver
In the event of an emergency, I hereby bive permission to the staff of St. Clare of Assisi Catholic Church to seek emergency medical transport or treatment for my child(ren) named above. I wish to be advised before further care is given by the hospital or doctor and I understand that all financial obligations are my responsibility. If I cannot be reached please contact the person listed above.

In consideration of my child's participation in Faith Formation, I agree on behalf of myself, my child(ren) named above, and our heirs, successors, and assigns, to indemnify, hold harmless and defend the Daniel Cardinal DiNardo, Archdiocese of Galveston-Houston, St. Clare of Assisi Catholic Church, its pastor or any representative of Faith Formation or Youth Ministry (collectively the "indemnitees") from any and all injuries, losses or claims arising out of my child's participation in the program. I further agree that if anyone on my child's behalf makes a claim against the indemnitees, I will indemnify, save, and hold harmless each of the indemnitees from any litigation, expenses, attorney fees, loss, liability, damage or cost which may incur as a result of such claim.

Medical/ Liability Waiver REQUIRED Please fill out this field.

Video/Photography Consent
As parent/guardian, I understand that promotional pictures and videos (individual and group) may be taken during Faith Formation Classes and/or Youth Ministry Activities. I give permission for my child(ren)'s (named above) pictures to be used for church promotional materials such as newsletters, web pages, calendars, power point presentations, or videos to promote or highlight these classes or activities.

Video/ Photography Consent REQUIRED Please fill out this field.

It truly takes a villiage to run these ministries and we cannot do it without you! Please consider sharing your time and talent with our parish through some of our many volunteer opportunities.

Are you interested in potentially volunteering in some capacity with Faith Formation for the 2021-2022 year?

Additional Notes

Complete Registration REQUIRED I understand that this registration will not be considered complete until final payment and/or a payment plan has been received and approved by St. Clare of Assisi Catholic Church. Please fill out this field.

Electronic Signature REQUIRED Please fill out this field. Please enter valid data.

St. Clare of Assisi Catholic Church

Houston, TX

St. Clare of Assisi Catholic Church
3131 El Dorado Blvd, Houston, TX 77059
(281) 286-7729

Faith Formation Registration