Religious Education Registration Form

Mother’s Name

Mother’s Maiden Name

Address

City

State

Zip

Phone Number

Email Address

Place and Date of Baptism

Please List all Sacraments Received

Will your child be receiving First Communion in May 2025
YesNo

What Grade will your child be entering in September 2024?

Does Your Child Attend Public or Parochial School?

If Parochial School, Specify

I am interested in more information about volunteering as a:
TeacherAsst. TeacherSubstitute

Emergency Contact

I Give Permission for My Child to be Published

MEDICAL CONCERNS:
Please inform us of any learning challenges, social concerns, medications, allergies or other information:
IMPORTANT INFORMATION: In an emergency, and if a parent cannot be contacted, you have my permission to contact the following person to help make decisions regarding the care for my child:
Name:

Relationship:

Home Phone #:

Cell Phone #:

I hereby consent and authorize Father Elie Mikhael or his designated representative, to obtain and provide for my son/daughter any and all medical care or treatment which might become necessary, until either parent or the emergency contact person can be reached. I further expressly release and waive Father Elie Mikhael, his designated representative, and St. Anthony Maronite Church, and the Eparchy of St. Maron of Brooklyn, from any liability, action, claim, cause of action which I might otherwise have in the event of illness or injury during the period that my son/daughter is attending the Religious Education.

PHOTO RELEASE (Please check appropriate box below)

AUDIO VISUAL TAPING AND PHOTOGRAPHY CONSENT: On occasion, videotape, audio tape, slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and another printed media.I / We consentdo not consent (check one) to the use of such materials in which I may appear. I release the staff and volunteers of St. Sharbel Mission and the Eparchy of St Maron of Brooklyn, NY from any liability connected with the use of my child’s picture or voice recording as part of any of the above or similar activities.

Parent Signature:

Date:

Registration fee $45.00

Cash

Check #

Venmo