Sacred Heart Parish Faith Formation Program: 2016-2017
Po Box 482, Lebanon, NH 03766-0482; Telephone: 603-448-1262 Email Jesse Dow:
FAMILY NAME: ______
Home Phone: ( )______Cell Phone (Mother):______Cell Phone (Father)______
Father’s Name: ______Father’s Religion: ______
Mother’s Name: ______Mother’s Religion:______
(first & maiden)
Street Address:______
Mailing Address:______
Parent email address: ______(For Church use only)
Grade 7-10 Student email address ______(***see below)
A Baptismal Certificate is required with the registration form for all children entering grades 1,2 and 10.
Please check here if baptized at Sacred Heart Parish or Holy Redeemer Parish.______. (If not see reverse side.)
Student/s Name: (Begin with eldest) (Please include child's last name if different from family name.)
First Name Middle Name Last Name DOB Grade Entering Homeschool (NOT 9th or 10th)
______
______
______
______
Please list and describe any learning disabilities and/or medical concerns your child has that may affect progress
______
***Additional information needed for Grades 2 & 10. Please see the back of this registration form***
REGISTRATION FEES (circle one): 1 child $50 2 children $80 3 or more children $100
Additional Program Fees: First Reconciliation/Communion Sacramental Prep students please include $35 for materials.
Grades 7-10 students please include $35 for NET retreat.
No child is ever denied a religious education because of financial burdens. Please contact Fr. Charles if you have special needs.
Registration fees waived for full time catechist volunteers. (Extra program fees are NOT waived). Contact the church office to volunteer!
PLEASE READ AND SIGN BELOW
I agree to have my child/children transported via ambulance and/or treated for emergency medical or dental problems if an emergency arises. I accept full responsibility for all medical expenses incurred as a result of my child/children's participation in this program.
I understand that occasionally photographs of my child may be taken and used for publicity, newspaper articles, and/or the Parish website. If I do NOT want my child's photograph used, I must notify the parish office in writing.
***(If grade 7-10 student email provided): I agree to allow communication by email with my grade 7-10 student(s) for church related purposes only with parent(s) copied on all items sent.
SIGNATURE (PARENT or GUARDIAN):______DATE:______
OFFICE USE ONLY: # of children grade K-10 ______Amount paid: $______
Sacred Heart Parish Faith Formation Program: 2016-2017
Sacramental Preparation, Grades 2 & 10:
Child’s FULL Name:______
(First) (Middle) (Last)
Date of Birth: _____/_____/______
Place of Birth: ______
(City) (State)
Date of Baptism: _____/_____/______
Place of Baptism: ______
(Parish)
______
(Street Address)
______
(City) (State)
**If your child was not baptized at Sacred Heart, Lebanon or Holy Redeemer, West Lebanon, a copy of your child’s baptismal certificate needs to be on file in the Sacred Heart Parish office. Please make sure it is submitted to the office with registration form.
Sacramental Preparation, Grade 10 Additional Information:
Date of First Reconciliation: _____/_____/______
Place of First Reconciliation: ______
(Parish)
______
(Street Address)
______
(City) (State)
Date of First Communion: _____/_____/______
Place of First Communion: ______
(Parish)
______
(Street Address)
______
(City) (State)