26900 78th Ave NW, PO Box 1002, Stanwood WA 98292 | 360-629-3737

Faith Formation Registration 2020-2021

Elementary - Kindergarten thru 5th Grade

Jr. High - 6th thru 8th Grade

Youth Group 9th - 12th grade

Fees: $25 for one - $45 for two - $65 for three or more.

Please pay at time of registration by cash or check through the Parish Office only or

payment online with credit card. Please click here for online payment.

Scholarship help available.

Call 360-629-4425 or e-mail Karen Boespflug at PAFF@saintccc.org

For 2nd Grade Students

2nd Grade Students will need to provide a copy of their Baptismal Certificate

This is for Office Use Only

Yes

Please provide the Baptismal Certificate copy by email to: paff@saintccc.org / Or by mailing to the church or dropping off at the Parish Office.

Child 1

Child's Name

First Name*

Last Name*

Birth Date

Required* //

Sex
Required*

	Male
	Female

Grade

Required*

School

Required*

Baptized
Required*

	Yes
	No

Eucharist
Required*

	Yes
	No

Confirmed
Required*

	Yes
	No

Child 2

Child's Name

First Name

Last Name

Birth Date

Sex

	Male
	Female

Grade

School

Baptized

	Yes
	No

Eucharist

	Yes
	No

Confirmed

	Yes
	No

Child 3

Child's Name

First Name

Last Name

Birth Date

Sex

	Male
	Female

Grade

School

Baptized

	Yes
	No

Eucharist

	Yes
	No

Confirmed

	Yes
	No

Child 4

Child's Name

First Name

Last Name

Birth Date

Sex

	Male
	Female

Grade

School

Baptized

	Yes
	No

Eucharist

	Yes
	No

Confirmed

	Yes
	No

Information Required

Date of Registration:

Required* //

Father's Name:

First Name*

Last Name*

Father's Phone:

Required* -- ext

Mother's Name:

First Name*

Last Name*

Mother's Phone:

Required* -- ext

Home Address

Street 1*

Street 2

City*

State*

Zip*

Home Phone

If different from Cell Phone Information -- ext

E-mail (Our correspondence is done by email):

Required*

Does child/children live with:
Required*

	Both Parents
	Father
	Mother
	Other

If you choose "Other" please explain

Is father Catholic?

	Yes
	No

Is mother Catholic?

	Yes
	No

Additional information:

Does your child have allergies? Special needs? Any additional information?	Please list anything we need to know to help your child.

Parent Authorization

PARENT AUTHORIZATION As parent and/or legal guardian, I remain legally responsible for any personal actions of my child/children. I give my permission for my child/children to take part in St. Cecilia Faith Formation. In consideration of the opportunity for my child/children to participate and fully recognizing that such an undertaking involves, an element of risk, we assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless the Archdiocese of Seattle, St. Cecilia Parish, its agents, employees, and officers, and the chaperones, leaders, organizers and sponsors, and persons transporting our childIchildren to and from these activities. Neither the Archdiocese of Seattle, St. Cecilia Parish, nor any of said persons shall be held financially responsible for any injury, illness, or death incurred as a direct or indirect result of this activity. If I cannot be reached, I request that the PAFF/Catechist/Pastoral Associate for Youth Ministry act in the best medical interests of my child and I agree to assume all expenses for moving and medically treating him/her. I also hereby consent to any treatment, surgery, diagnostic procedures or the administration of anesthesia which may be carried out based on the medical judgment of the attending physician. Please understand that to be in compliance with the Archdiocese of Seattle and to keep your child safe this form needs to be signed and on file for your child/children to enter the classroom. Thank you. Photos: From time to time, pictures and video may be taken of youth ministry/parish/school events and gatherings. We would like to be able to use these photographs and videos for flyers, parish and diocesan publications, and the ministry website. Written consent of the parent/guardian is required. Names will not be posted unless written authorization is given by the student and parent/guardian, and then only first names will be used. If there are concerns about pictures or videos posted on the website, please contact the organization or webmaster, and they will promptly be removed.

Please check preference

	I allow photos of my child
	I DO NOT allow photos of my child

Parent/Guardian Signature Agreement

Typing your name will indicate that all information completed is true and you authorize the above agreement.

Parent/Guardian Signature

Required*

Date

Required* //

Emergency Names & Contact Numbers

1st Emergency Contact Name

First Name*

Last Name*

1st Emergency Contact Phone

Required* -- ext

2nd Emergency Contact Name

First Name

Last Name

2nd Emergency Contact Phone

-- ext

Physician's Name

First Name

Last Name

Physician's Phone

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Faith Formation Registration 2020-2021

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