St. Elizabeth/ St. Mark CCD Registration Form

Family Information
Student's Name
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Gender
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Mother's Name
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Father's Name
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Address
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Home Phone --
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Cell Phone --
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E-mail
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What Parish is your Family Registered at?
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Student's Information
Child's Date of Birth //
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Place of Birth
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Age
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Grade
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Date of Baptism //
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Church of Baptism
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If new to the program, Please send a copy of Baptismal Certificate to stelizabethbearcreek@outlook.com or bring a copy into the Parish office.
School Child Attending
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Emergency Contact Information
Name
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Relationship
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Phone --
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Does your child have any food allergies?
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Agree & Sign
Message In the event of an emergency, in which I cannot be contacted, emergency staff may take appropriate action to best serve the interest of the child. Therefore, in consideration of your acceptance of this registration, i hereby for myself, my heirs, and assignees waive any and all claims for damages which i might have against St. Elizabeth-St. Mark Parish Community for any and all injuries suffered by my child.
Electronic Signature
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Date //
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