Re-Registration Form

Parent/Family Information

Family Name:

Primary Contact e-mail

Re-enter Primary Contact e-mail

Has your cell phone number changed? If YES, please specify:

Has your address changed? If YES, please provide your new address below:

Mailing Address

Mailing City

Mailing State

Mailing Zip

Student Information

First Name

Last Name

Public School Attending

Grade

Will attend weekly in-person classes?

Check to add a second child:

In Case of Emergency Information

(Person to Contact If Parent/Legal Guardian Cannot Be Reached) Emergency Contact (EC)

EC First Name

EC Last Name

Relationship to Child (ren)

EC Phone Number

Doctor for Emergency

Doctor's Phone Number

I understand that in case of an emergency, “911” will be called and an ambulance may be called by the Director of Religious Education or her designate.

In case of accident or illness, I request that the representative of the parish catechetical program contact me. If I am unable to be reached, I hereby authorize this representative to call the physician indicated and to follow the physician’s instructions. If it is impossible to contact this physician, the representative of the parish catechetical program may make whatever arrangements seem necessary. I agree to assume the financial responsibility for any diagnosis, treatment and/or medication deemed necessary.

I have read and understand the emergency information:

Parent Handbook

I have read the Parent Handbook (www.annunciation-fatima.com/religious-education) and agree to its contents:

Signature:

I (insert your name below), to the best of my knowledge, have provided information that is accurate and complete.

Name for signature:

Annunciation - Our Lady of Fatima Religious Education
Re-Registration Form

Parent/Family Information

Student Information

Child 2

Child 3

Child 4

In Case of Emergency Information

Parent Handbook

Signature:

Re-Registration Form

Annunciation - Our Lady of Fatima Religious Education Re-Registration Form

Parent/Family Information

Student Information

Child 2

Child 3

Child 4

In Case of Emergency Information

Parent Handbook

Signature:

Annunciation - Our Lady of Fatima Religious Education
Re-Registration Form