ST. TIMOTHY / SAINT RITA FAITH FORMATION Office use only
2019-2020 Date:___________
NEW REGISTRATION Paid:___________
Check #:_________
All classes are held on Sundays. Children in Grades K-5 meet from 10:00 AM-11:15 AM. – Students in Grades 6-10 meet from 6:00 -7:15 PM.. Attendance at Mass constitutes part of the teaching. All classes meet in accordance with a set schedule. You must be registered at St. Timothy Church or St. Rita Church for your child/children to participate in our Faith Formation program.
Are you a registered member of St. Timothy Parish? _____Yes _____ No, St. Rita Parish? ____Yes_____No. If not, please contact us for a parish registration form.
FAMILY NAME:___________________________________________________________________________________________________
STUDENT NAME(S):_______________________________________________________________________________________________
ADDRESS:________________________________________________________________________________________________________
HOME PHONE:__________________________CELL (MOM):_________________________CELL (DAD):_________________________
E-MAIL ADDRESS:__________________________________________________________________________________OUR PRIMARY COMMUNICATION WITH YOU IS VIA E-MAIL. CHECK HERE:_____IF YOU DO NOT HAVE AN E-MAIL ADDRESS
IN CASE OF AN EMERGENCY WHERE WE ARE NOT ABLE TO CONTACT YOU, PLEASE INDICATE THE PERSON(S) TO BE CONTACTED:
NAME:__________________________________________________________PHONE:____________________CELL:________________
MEDICAL OR /BEHAVIORAL CONDITIONS:____________________________________________________________________________________________________
FATHER OR MALE GUARDIAN MOTHER OR FEMALE GUARDIAN
RELATIONSHIP TO CHILD:___________________________ RELATIONSHIIP TO CHILD:______________________________
NAME:___________________________________________________NAME:_________________________________________________
OCCUPATION:____________________________________________OCCUPATION:_________________________________________
BUSINESS PHONE:_________________________________________BUSINESS PHONE:______________________________________
RELIGION:________________________________________________RELIGION:_____________________________________________
MARITAL STATUS:________________________________________MARITAL STATUS:______________________________________
MAIDENNAME:_________________________________________
For the registration fee for the upcoming school year please call or email the Faith Formation Office.
All checks should be made payable to St. Timothy Church.
A COPY OF THE CHILD’S BAPTISM CERTIFICATE MUST BE PROVIDED FOR OFFICE RECORDS,(if baptized in a church other than St. Timothy/St. Rita), BEFORE ANY OTHER SACRAMENT CAN BE RECEIVED. Please contact the Church where your child was baptized and have them fax us a copy of his/her Baptism Certificate. Our Fax number is 738-2466. In the event you child has not been baptized, please provide us with a copy of your child’s Birth Certificate.
If your child has had religious instruction elsewhere, please indicate their name(s) and the name of the parish.
STUDENT NAME(S):___________________________________________________________________________
CHURCH NAME:__________________________________________GRADE(S):___________________________
STUDENT 1 Faith Formation entering grade:________ Is this child in a different grade in school? If so, what grade:_____
STUDENT NAME:____________________________________ MIDDLE NAME: __________________________________
DATE OF BIRTH____/____/____GENDER :_______________SCHOOL:_________________________________________
Has this child been adopted? _____Yes _____No If so, please provide a copy of the Adoption Certificate.
Student resides with: (__both parents) (___mother) (___father) (___other NAME: _______________________________)
Are there any special circumstances regarding child custody or persons to whom your child may not be released?
If so, please explain.______________________________________________________________________________________
RELIGION:_____________________________ Has this student been baptized in the Roman Catholic Church?___YES___NO
Address of the Church where the student was baptized: __________________________________________________________
______________________________________________________________________________________________________
Has this student been baptized in another Christian denomination? If so, please list:___________________________________
Has this student made his/her First Penance? ___YES ___NO
Has this student made his/her First Communion? ___YES ___NO
HEALTH PROBLEMS: __________________________________ Does your child have any allergies? _____YES_____NO
Food(s):________________________________________________Other allergies:___________________________________
Does your child carry an Epi-Pen or have medication of any type with them?_________________________________________
Does your child have any special learning needs and if so, does he/she require any special accommodations?
If yes, please explain._____________________________________________________________________________________
STUDENT 2 Faith Formation entering grade:________ Is this child in a different grade in school? If so, what grade:_____
STUDENT NAME:____________________________________ MIDDLE NAME: __________________________________
DATE OF BIRTH____/____/____GENDER :_______________SCHOOL:_________________________________________
Has this child been adopted? _____Yes _____No If so, please provide a copy of the Adoption Certificate.
Student resides with: (__both parents) (___mother) (___father) (___other NAME: _______________________________)
Are there any special circumstances regarding child custody or persons to whom your child may not be released?
If so, please explain.______________________________________________________________________________________
RELIGION:_____________________________ Has this student been baptized in the Roman Catholic Church?___YES___NO
Address of the Church where the student was baptized: __________________________________________________________
______________________________________________________________________________________________________
Has this student been baptized in another Christian denomination? If so, please list:___________________________________
Has this student made his/her First Penance? ___YES ___NO
Has this student made his/her First Communion? ___YES ___NO
HEALTH PROBLEMS: __________________________________ Does your child have any allergies? _____YES_____NO
Food(s):________________________________________________Other allergies:___________________________________
Does your child carry an Epi-Pen or have medication of any type with them?_________________________________________
Does your child have any special learning needs and if so, does he/she require any special accommodations?
If yes, please explain._____________________________________________________________________________________
In the event of any emergency, I hereby give permission to transport my child/children to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.
Doctor:_________________________________________________________________Phone:_________________
Volunteer positions include: Teacher, Aide, Sub, Hall Monitor, and Office Assistant
I wish to volunteer for: ___________________________________________________________________________________________
Even if you cannot volunteer for any of the positions above, do you have some particular talent you are willing to share, such as music, arts & crafts, sewing/altering costumes, drama experience, baking, etc.? ___Yes ___No
Please list: ________________________________________________________________________________________________________
When I had my child/children baptized, I accepted responsibility as primary religious educator and example in matters of the faith. I know that the Church is here to support me in educating my child in our Catholic faith.
PARENT SIGNATURE:___________________________________________________DATE:_________________