- St. John the Baptist Catholic Church

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Are you a Registered Parishioner REQUIRED Yes No Please fill out this field.
Family Information
- Mother's Name (Include Maiden 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.
- Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Work Phone Number Maximum 20 characters Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Father's Name REQUIRED Please fill out this field. Please enter valid data.
- Address (if different from Mother) Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Email Please enter an email address.
- Phone Number Maximum 20 characters Please enter a phone number.
- Are you Catholic? Yes No
- Guardian's Name (if applicable) Please enter valid data.
- Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Email Please enter an email address.
- Phone Number Maximum 20 characters Please enter a phone number.
- Are you Catholic? Yes No
Student Information
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Male Female Please fill out this field.
- Child Lives With REQUIRED Both Parents Mother Father Guardian Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Name of School REQUIRED Please fill out this field. Please enter valid data.
- Grade in School REQUIRED Please fill out this field. Please enter valid data.
- Baptized? REQUIRED Yes No Please fill out this field.
- Date Please enter a date.
- Name of Church & Address Please enter valid data.
- First Communion? REQUIRED Yes No Please fill out this field.
- Date Please enter a date.
- Name of Church & Address Please enter valid data.
- Confirmation? REQUIRED Yes No Please fill out this field.
- Date Please enter a date.
- Name of Church & Address Please enter valid data.
- List any chronic health conditions, allergies, recent serious illness or injury:
- List any educational or behavioral needs:
Parent/Guardian Agreement
- I understand that I, as parent or legal guardian of the child listed above, am required to read the Parent Handbook provided by the Religious Education program at St. John Catholic Parish. I understand and agree to abide by the guidelines, rules and regulations set forth in this handbook. I understand that my child(ren) need(s) to observe the basic rules of conduct, and adhere to the rules stated in the handbook. I understand that failure to comply with the family handbook could bring about disciplinary actions including, in extreme cases, dismissal of my child from the catechetical program.
  
  I understand that I am responsible for sharing the rules, regulations and other important information in this handbook with my child.
  
  I Agree Please select this field.
- Signature (PRINT FULL NAME IN ALL CAPS) REQUIRED Please fill out this field. Please enter valid data.
- Date REQUIRED Please fill out this field. Please enter a date.
- Relationship to Child REQUIRED Please fill out this field. Please enter valid data.
Pickup Authorization
- We encourage all parents to come into the classroom when dropping off or picking up your children. If your child is the 4th grade or lower, it is mandatory that someone come into the classroom to pick up your child. If a sibling will pick up your child, they must be in the 5thgrade or higher.
  
  Please list all who have permission to pick up your child:
- Who can pickup your child? REQUIRED Please fill out this field.
Medical Release
- As a parent and/or guardian, I do herewith authorize the treatment of my child by a qualified and licensed medical doctor of the following minor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after reasonable effort has been made to reach me first or the emergency contact person listed below.
- Name of Minor REQUIRED Please fill out this field. Please enter valid data.
- 1st Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
- Relationship to child REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- 2nd Emergency Contact REQUIRED Please fill out this field. Please enter valid data.
- Relationship to child REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
This release form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence and only after all efforts have been made to reach me or the emergency contact person(s) listed.
I Agree Please select this field.
Signature of Parent or Guardian (TYPE NAME IN ALL CAPS) REQUIRED Please fill out this field. Please enter valid data.
Date REQUIRED Please fill out this field. Please enter a date.
4 + 6 = REQUIRED Please fill out this field. Please enter valid data.

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St. John the Baptist CATHOLIC CHURCH

GRAND BAY, ALABAMA

Student Registration Form