2021-2022 Registration (FF, & YM)

Family Last Name:

Name REQUIRED Please fill out this field. Please enter valid data.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Preferred Email REQUIRED Please fill out this field. Please enter an email address.
Are you currently registered as a parishioner at St. Kateri Tekakwitha? REQUIRED Please fill out this field.
*If no, where? Please enter valid data.

First Parent/Guardian Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to Student REQUIRED Please fill out this field.
Parent/Guardian Address
Cell Phone Number REQUIRED Please fill out this field. Please enter valid data.
Marital Status REQUIRED Please fill out this field.
Additional/Alternative Email
Optional
Please enter an email address.

Second Parent/Guardian Information

Emergency Contact Information

In the event of an emergency or cancellation of sessions or activities, I agree to allow the St. Kateri Tekakwitha Parish Data System to send me a text message. REQUIRED Yes No Please fill out this field.
Preferred number to receive texts Please enter a phone number.
Cell Service Provider Please enter valid data.

Non-Parent Emergency Contact

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to student: Please enter valid data.
Home Phone Number Please enter a phone number.
Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Non-Parent Pick-Up Contacts

If I am unable to pick up my child(ren), the following people ARE permitted to pick them up:
Contact #1
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Contact #2
First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.
If there are additional contacts you would like to give permission to, please use the following drop-down option. Children will not be released to parties without parent approval.

How many additional Pick-Up contacts are you listing? REQUIRED Please fill out this field.
Pick-Up Contact 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Pick-Up Contact 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship to Student REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Student Registration

Registration Tuition for both in-person and virtual instruction. REQUIRED Please fill out this field.

Photo Release

I grant permission to the Faith Formation and Youth Ministry staff and its designated representatives to take photos and video of my child(ren) for use in parish publications, parish website and social media. REQUIRED Yes, I give permission. No, I do not give permission. Please fill out this field.

Volunteering

Permissions/Acknowledgements

I understand I need to provide a copy of my child(ren)'s baptismal certificate(s) if my child(ren) is/are receiving sacraments this year and was/were not baptized at St. Kateri Tekakwitha, St. Helen, or Our Lady of Fatima.
I Agree Please select this field.
I understand I must disclose any allergies and/or ADA needs or special needs the staff and volunteers need to know to provide proper care, attention, and adjustments for the well-being of my child(ren) while in their care. I accept full responsibility for any injuries/penalties/deaths that may result if I do not properly disclose this information to the St. Kateri staff and designated volunteers.
I Agree Please select this field.
I agree that if I need to cancel or amend my registration, that I will receive back the costs paid for my registration minus the cost of processing fees as determined by St. Kateri Tekakwitha parish.
I Agree Please select this field.
Are there any additional questions/comments/concerns you would like us to address concerning your child(ren)'s registration?

Saint Kateri Tekakwitha Parish