Faith Formation Registration Form

Faith Formation Registration

Registration is open for the 2023-2024 Faith Formation Class Year for Grades K-8 for all parishioners.

Please fill in and submit the form below.

All requirements are for the protection of your child/children and must be met before the student is permitted to attend class.

Read Faith Formation Orientation here (includes everything you need to know)
If you would like a paper copy of the release forms for your records, please see the Catechist.
Pay the registration fee. (Scholarships available, must meet specific qualifications)
Payment can be made online by above attached link.
Payment made by check or cash, are to be dropped off in the Parish Office

Registration is not complete until all requirements are met.

Any questions please call (386) 668-8270, or email Dr. Lydia Navarro at lnavarro@stannsdebary.org

Faith Formation Registration Form

Registration Date:

Title:

Last Name:

First Name:

Current Marital Status:

Religion

Occupation:

Main Email Address:

Main Phone Number (include area code)

Second Phone Number:

Home Address: (include Apt. or Bldg. #)

City:

State:

Zip Code:

Title:

Spouse Last Name:

Spouse First Name:

Email Address:

Religion:

Occupation:

What Mass Do You Regularly Attend?

Language(s) spoken at home:

STUDENT INFORMATION

(1) Student Name:

Gender:

DOB:

School Grade:

Date of Baptism:

First Communion

(2) Student Name:

Gender:

DOB:

School Grade:

Date of Baptism:

First Communion:

(3) Student Name:

Gender:

DOB:

School Grade:

Date of Baptism:

First Communion:

(4) Student Name:

Gender:

DOB:

School Grade:

Date of Baptism:

First Communion:

PARENTAL/GUARDIAN MEDICAL INFORMATION & CONSENT

FIRST and LAST NAME:

RELATIONSHIP

Phone Number

EMERGENCY MEDICAL TREATMENT:

Permission to Transport

MEDICATIONS:

List Medication, Dosage and Administer

MEDICAL CONDITIONS INFORMATION

Reasonable steps will be taken to keep this information confidential, but it will be shared with the Diocesan personnel and others, as warrented.

My son/daughter is allergic to the following medications.

List items that may cause allergic reactions:

My son/daughter has had an episode or has been diagnosed with Seizures

My son/daughter has had an episode or has been diagnosed a Diabetic.

My son/daughter has had medical surgery within the last six months.

My son/daughter is still under doctor's care

My son/daughter has a medically prescribed diet .

My son/daughter has the following physical limitations, and you should also be aware of these special medical conditions .

My son/daughter immunizations are current and up to date?

HEALTH INSURANCE INFORMATION

Do you carry medical insurance at this time?

Name of Insured:

Insurance Carrier:

Insurance Policy Number:

Field label

In the event the participant does not have insurance, payment in full for medical care becomes the responsibility of the participant's parent/guardian.

FIRST and LAST NAME:

IMAGE RELEASE FORM

Image Release

Agreement: I agree that typing my First and Last name is the legally binding equivalent to my handwritten signature.

FIRST and LAST NAME

Free Text

Opt-In or Opt Out

Free Text

For the Parent/Guardian, By signing this form I (We) acknowledge the above and elect (NOT TO) have my (Our) child participate, or give my permsission for them (TO) participate in the aforementioned program. Please complete this form. A separate form is required for each child. Thank you for your assistance.

FIRST and LAST NAME

Field label

Agreement: I agree that typing my First and Last name is the legally binding equivalent to my handwritten signature.

Field label

COVID-19 ASSUMPTION OF RISK AND WAIVER

Free Text

FIRST and LAST NAME:

Free Text

Agreement: I agree that typing my First and Last name is the legally binding equivalent to my handwritten signature.

Additional Persons allowed to pick up your child.

If there's no other child/children to register:

I read the Faith Formation Orientation Document.

It includes everything you need to know about the program. Link can be found at the top of this form.

Thank you for enrolling your child in St. Ann's Faith Formation Program. We are happy and grateful to be able to share our beautiful Catholic Faith with your child.

Please scroll to the bottom and submit the form.

Electronic Signature

DATE:

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About us

We welcome you all to be part of our community.

Useful Links

Contact info

St. Ann's Catholic Parish

26 Dogwood Trail

DeBary, FL 32713

Phone: (386) 668-8270

Fax: (386) 668-8471

Email: office@stannsdebary.org

Office Hours:

Monday, Tuesday, Wednesday and Thursday:
Open: 8:30am-4pm

Office closes for lunch from: 12pm-1pm

Friday Office Hours: 8:30am - 12Noon

Join our family!

Admin

Faith Formation Registration

Registration is not complete until all requirements are met.

Faith Formation Registration Form

Daily Readings

Online Giving

About us

We welcome you all to be part of our community.

Useful Links

Contact info

St. Ann's Catholic Parish

26 Dogwood Trail

DeBary, FL 32713

Phone: (386) 668-8270

Fax: (386) 668-8471

Email: office@stannsdebary.org

Office Hours:

Monday, Tuesday, Wednesday and Thursday: Open: 8:30am-4pm

Office closes for lunch from: 12pm-1pm

Friday Office Hours: 8:30am - 12Noon

Join our family!

Monday, Tuesday, Wednesday and Thursday:
Open: 8:30am-4pm