"A FAMILY OF FAITH" REGISTRATION FORM
SUNDAY MORNING PROGRAM: OFFERED IN ENGLISH AT CHURCH FOR CHILDREN K-8th WITH BILINGUAL ACTIVITY BOOK AVAILABLE.   ENGLISH OR SPANISH FOR ADULTS.
Email *
HYBRID PROGRAM THAT MEETS 1ST, 2nd AND 4TH SUNDAY FROM 10:30 A.M- 12:00 NOON AT CHURCH FOR CLASSES OR COMMUNITY GATHERING.  THE OTHER WEEK, THE PARENTS TEACH ONE LESSON AT HOME TO THEIR FAMILY IN A FAMILY STYLE TEACHING.  SEE SHEPHERDCATHOLIC.COM UNDER "FAITH FORMATION" TO SEE SCHEDULE AND DETAIL DESCRIPTION OF THIS PROGRAM. .  Cost:  One Whole Family Price:  One child family: $30.00, Two child family:$35 Three or larger family: $40
Mother's  Name *
Father's  Name
Parent's primary Cell Phone(s) *
Parent's Email *
Home Address *
Children live with whom *
First Child's full Name and grade level *
Has your child made their first communion *
Required
Second Child's Name and grade level *
Has your second child made their first communion *
Required
Third Child's name and grade level
Has your third child made their first communion *
Required
4th child's name and grade level
Has your fourth child made their First Communion?
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Which children have NOT been baptized? *
Are  you registered with Shepherd of the Valley?
In case of illness, accident or emergency to the student(s) named above, the Archdiocese of Portland and its representatives are authorized to proceed as indicated below in order of desired action I wish you to take. ( Add Mother, Father, and other person, Day Phones, and which Hospital you would like us to take them to in case of injury or emergency)   *
Are there any medical conditions or special needs you think we should know about to help keep them safe or more comfortable in our classes?  Joyce Marks will be in contact with you in how best to do this.  (Include name of the child if registering more than one.)
Allergies *
Is child presently on any medications? If so, state name, dosage, reason for drug and prescription physician. *
Name of Medical Insurance Company *
Group or I.D. Number *
I authorize the Archdiocese of Portland and its representative to use their judgment in determining emergency care and procedures for my child.  I also understand and agree that the Archdiocese assumes no financial obligation for expense incurred in carrying out emergency procedures and/or emergency transportation. Please check the box to electronically sign *
Required
You have permission to take pictures of our family during the 2022-2023 year program and to post on our Church Facebook or flocknote to share rel. ed events with others.  By checking the box you are giving us permission to do so.
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