Rectory:
(914) 779-7345
School:
(914) 337-8760
Religious Education:
(914) 779-2374
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Religious Education Registration
Home
Religious Education Registration
Annunciation - Our Lady of Fatima Religious Education: Registration Form
Parent/Family Information
Family Name:
Parish Envelope Number:
Mailing Address
Mailing City
Mailing State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip
Primary Contact Cell Number
Primary Contact e-mail
Re-enter Primary Contact e-mail
Mother's First Name
Mother's Last Name
Mother's Maiden Name
Mother's Religion
Mother's Cell Number
Mother's Alternate Emergency Number
Father's First Name
Father's Last Name
Father's Religion
Father's Cell Number
Father's Alternate Emergency Number
Student Information
First Name
Last Name
Date of Birth
Resides With
---
Both Parents
Mother
Father
Other
Public School Attending
Grade
Is student new or returning?
---
New
Returning
Baptism Date
Church
Copy of baptismal certificate attached:
Will attend weekly in-person classes?
---
Yes
No
In lieu of in-person learning, I agree to provide catechesis at home under the direction of the Annunciation- OLF Rel Ed department.
---
Yes
No
Does your child have any special learning accommodations or needs?
---
Yes
No
Please Specify:
Does your child have a special medical condition or allergies that may lead to a
medical emergency of which we should be aware?
---
Yes
No
Description of special medical condition
Procedures to be followed if this condition becomes an emergency:
My child has allergies that require medication or can present an emergency?
---
Yes
No
List Allergies:
Course of action to be followed if allergy presents an emergency condition:
What medication will be administered?
Name of person who will administer medication in case of emergency:
Where will this medication be kept so as to be readily available?
What other actions should be taken?
By Whom?
Whenever emergency medication is administered, “911” will be called without exception.
I (insert your name below) hereby consent to, and authorize the necessary procedures that have been stated above.
Name for signature
Do we have your permission to share this information with your child's Catechist?
---
Yes
No
Check to add a second child:
Child 2
First Name
Last Name
Date of Birth
Resides With
---
Both Parents
Mother
Father
Other
Public School Attending
Grade
Is student new or returning?
---
New
Returning
Baptism Date
Church
Copy of baptismal certificate attached:
Will attend weekly in-person classes?
---
Yes
No
In lieu of in-person learning, I agree to provide catechesis at home under the direction of the Annunciation- OLF Rel Ed department.
---
Yes
No
Does your child have any special learning accommodations or needs?
---
Yes
No
Please Specify:
Does your child have a special medical condition or allergies that may lead to a
medical emergency of which we should be aware?
---
Yes
No
Description of special medical condition
Procedures to be followed if this condition becomes an emergency:
My child has allergies that require medication or can present an emergency?
---
Yes
No
List Allergies:
Course of action to be followed if allergy presents an emergency condition:
What medication will be administered?
Name of person who will administer medication in case of emergency:
Where will this medication be kept so as to be readily available?
What other actions should be taken?
By Whom?
Whenever emergency medication is administered, “911” will be called without exception.
I (insert your name below) hereby consent to, and authorize the necessary procedures that have been stated above.
Name for signature
Do we have your permission to share this information with your child's Catechist?
---
Yes
No
Check to add a third child:
Child 3
First Name
Last Name
Date of Birth
Resides With
---
Both Parents
Mother
Father
Other
Public School Attending
Grade
Is student new or returning?
---
New
Returning
Baptism Date
Church
Copy of baptismal certificate attached:
Will attend weekly in-person classes?
---
Yes
No
In lieu of in-person learning, I agree to provide catechesis at home under the direction of the Annunciation- OLF Rel Ed department.
---
Yes
No
Does your child have any special learning accommodations or needs?
---
Yes
No
Please Specify:
Does your child have a special medical condition or allergies that may lead to a
medical emergency of which we should be aware?
---
Yes
No
Description of special medical condition
Procedures to be followed if this condition becomes an emergency:
My child has allergies that require medication or can present an emergency?
---
Yes
No
List Allergies:
Course of action to be followed if allergy presents an emergency condition:
What medication will be administered?
Name of person who will administer medication in case of emergency:
Where will this medication be kept so as to be readily available?
What other actions should be taken?
By Whom?
Whenever emergency medication is administered, “911” will be called without exception.
I (insert your name below) hereby consent to, and authorize the necessary procedures that have been stated above.
Name for signature
Do we have your permission to share this information with your child's Catechist?
---
Yes
No
Check to add a fourth child:
Child 4
First Name
Last Name
Date of Birth
Resides With
---
Both Parents
Mother
Father
Other
Public School Attending
Grade
Is student new or returning?
---
New
Returning
Baptism Date
Church
Copy of baptismal certificate attached:
Will attend weekly in-person classes?
---
Yes
No
In lieu of in-person learning, I agree to provide catechesis at home under the direction of the Annunciation- OLF Rel Ed department.
---
Yes
No
Does your child have any special learning accommodations or needs?
---
Yes
No
Please Specify:
Does your child have a special medical condition or allergies that may lead to a
medical emergency of which we should be aware?
---
Yes
No
Description of special medical condition
Procedures to be followed if this condition becomes an emergency:
My child has allergies that require medication or can present an emergency?
---
Yes
No
List Allergies:
Course of action to be followed if allergy presents an emergency condition:
What medication will be administered?
Name of person who will administer medication in case of emergency:
Where will this medication be kept so as to be readily available?
What other actions should be taken?
By Whom?
Whenever emergency medication is administered, “911” will be called without exception.
I (insert your name below) hereby consent to, and authorize the necessary procedures that have been stated above.
Name for signature
Do we have your permission to share this information with your child's Catechist?
---
Yes
No
Pickup/Drop off Information
Authorized people who can act as parent substitute and pick up/drop off the student(s)
First Name
Last Name
Relationship to Child
---
Caregiver
Grandparent
Aunt
Uncle
Neighbor
other
Cell Number
First Name
Last Name
Relationship to Child
---
Caregiver
Grandparent
Aunt
Uncle
Neighbor
other
Cell Number
First Name
Last Name
Relationship to Child
---
Caregiver
Grandparent
Aunt
Uncle
Neighbor
other
Cell Number
First Name
Last Name
Relationship to Child
---
Caregiver
Grandparent
Aunt
Uncle
Neighbor
other
Cell Number
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)
---
Caregiver
Grandparent
Aunt
Uncle
Neighbor
other
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:
---
Yes
No
Parent Handbook
I have read the Parent Handbook (
www.annunciation-fatima.com/religious-education
) and agree to its contents:
---
Yes
No
Signature:
I (insert your name below), to the best of my knowledge, have provided information that is accurate and complete.
Name for signature:
